Telehealth Authorization Form

Telehealth Authorization Form

Please read and fill out the form below. By clicking on Accept Terms you agree to the information provided on this page.

Telehealth is the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely. These technologies can be used from home by you and your provider to improve or support ABA treatment services.

As a result of the “stay at home order” issued by Governor Gavin Newsom, Behavioral Concepts is implementing the use of Telehealth to continue to provide our staff and families with support and services. This includes:

  • Supervision of behavior interventionist via a video call during session
  • Consultation with parent/caregiver via phone call or video call during or outside of session
  • Conference call between any/all team members to discuss programming, questions, or concerns

Reasonable and appropriate efforts will be made to eliminate any confidentiality risks associated with services provided via telehealth, by using only non-public facing remote communication products. All existing confidentiality protections under federal and California State law apply to information disclosed during all telehealth services.

Telehealth services will continue until we have been instructed by the state that they are no longer required.

By signing this document below, you are consenting to have confidential telehealth services with Behavioral Concepts’ staff during the period of the COVID-19 lockdown.