42189 Ann Arbor Road, Plymouth, MI 48170

(734) 453-5603

(734) 453-5603

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    • Home
    • Services
    • Meet Us
    • New Patient Forms
    • License Reinstatement
    • Directions
    • Insurances
    • Careers
    • Contact Us
  • Home
  • Services
  • Meet Us
  • New Patient Forms
  • License Reinstatement
  • Directions
  • Insurances
  • Careers
  • Contact Us

Access Behavioral Associates, LLC.

Access Behavioral Associates, LLC.Access Behavioral Associates, LLC.Access Behavioral Associates, LLC.

New Patient Forms

Please download and BRING the applicable forms to your first appointment. If you choose to complete the paperwork at the clinic you may arrive for your appointment 30 minutes before your scheduled appointment time. If you have any questions, do not hesitate to call our office staff at (734) 453-5603. Thank you.

 

Please bring a picture ID and your insurance/HMO card. Ensure all forms are complete and with signatures. You may give your completed forms to office staff or your clinician (after hours).

 

Please complete the Adult Personal History Questionnaire (age 18+) or Child/Adolescent Personal History Questionnaire - whichever questionnaire applies to you.

ADMINISTRATIVE FORMS, ALL PATIENTS

(download/print, complete and bring to first session).

*You will complete consent to treatment and fee agreement after completion at ABA.

Patient Registration Form (rtf)

Download

Personal History Forms

(download/print, complete and bring to first session).

Adult Personal History Questionnaire (age 18+) (doc)

Download

Child/Adolescent Personal History Questionnaire (doc)

Download

All new patients must review the below forms.

Please direct questions to your therapist.

Patient Important Information (doc)

Download

Privacy Notice (doc)

Download

Custody Situations

(as applicable)


Joint legal custody is defined as both parents' ability to make all major decisions regarding their children. When considering a minor child for treatment, joint legal custody requires both parents' signature on the Consent to Treatment form. Sole legal custody requires court documents stating the custody arrangement. Please consult legal advice if you need further information.

Access Behavioral Associates, LLC.

42189 Ann Arbor Road, Plymouth, MI 48170

To schedule an appointment call (734) 453-5603

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