Access Family Services

Application for ABA Services

Date of Survey: (required)


Select Your Preferred Location (required)




Services Received:

Intensive In HomeFamily Centered TreatmentOutpatientFoster CareSchool-Based TherapyDay TreatmentABA ServicesMedication Management


Please rate our services below using the following scale. 1-Agree, 2-Neutral, 3-Disagree:

My/My child’s symptoms have improved as a result of treatment received (required)

1 - Agree2 - Neutral3 - Disagree


Staff treated me/my family with respect for my cultural and personal preferences (required)

1 - Agree2 - Neutral3 - Disagree


I would recommend AFS to a friend who needed services (required)

1 - Agree2 - Neutral3 - Disagree


If you are neutral or disagree with any of the statements, we would appreciate hearing your concerns or suggestions for improvement in the space below: (required)




If you would like for our agency to contact you to discuss these concerns, please indicate this and provide us with a contact number:


HIPAA Compliance

As a client of Access Family Services, a record of health information is made. In adhering to our Best Practices for HIPAA Compliance, we have made our HIPAA, Confidentiality & Privacy Practices document available for download.

HIPAA, Confidentiality & Privacy Practices
[Download]

Client Rights Handbook

As a service to Access Family Services clients,, we have made our Client Rights Handbook available for download.

Client Rights Handbook
[Download]

 

Client Rights Handbook
(En Español)
[Download]