Achieving Abilities Legal Guardianship Declaration & Consent for ABA Services
Understanding Our Custody & Consent Process
Welcome! Before we can begin ABA services for your child, we are legally required to verify custody arrangements and obtain proper consent. If you are a divorced parent, a legal guardian, or part of a blended family, please follow the steps below to complete our Legal Guardianship Declaration & Consent Form.
Step 1: Gather Your Documents
Step 2: Identify the Legal Decision-Maker
Step 3: Quote Your Decree
Step 4: Upload Your Proof of Custody
Step 5: E-Sign for Authority & Consent
Before you start the form, please have your most recent, court-stamped Divorce Decree, Custody Agreement, or Certificate of Custody readily available. You will need to reference it and upload a copy.
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Note to Step-Parents: While we value your role in your child's life, this form must be completed and signed by the biological parent or individual who holds the legal right to make medical decisions.
In the first section of the form, you will be asked to identify who holds the legal authority to consent to medical services.
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If your custody agreement states that parents must make decisions together, but one parent has the "final say" or tie-breaking authority (e.g., Mom gets to make the final decision), you will need to indicate that on the form.
We want to honor your family's exact legal arrangement. The form will ask you to type or paste the specific paragraph from your Divorce Decree that outlines medical and educational decision-making.
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Example: "The parents will discuss with each other and mutually decide the significant decisions regarding the children..."
You will be prompted to securely upload a clear photo (JPG/PNG) or PDF of your Divorce Decree or Certificate of Custody. We must have this official document on file before ABA services can begin.
Finally, you will be asked to provide two digital signatures:
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Legal Attestation: A signature swearing that you have provided the most up-to-date legal documents and have the authority to make decisions for the child.
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Consent to ABA Services: A signature officially granting Achieving Abilities, LLC. permission to begin Applied Behavior Analysis (ABA) therapy.
Once submitted, our team will review the documents. If everything is clear and authorized, we will move forward with scheduling!
Consent for ABA Services and Financial Responsibility
1. Authorization for Treatment I, the undersigned legal decision-maker, hereby grant explicit permission to Achieving Abilities, LLC., its Board Certified Behavior Analysts (BCBAs), Registered Behavior Technicians (RBTs), and affiliated clinical staff to conduct behavioral assessments and provide Applied Behavior Analysis (ABA) treatment for the child named above. I understand that ABA therapy involves observation, data collection, and direct therapeutic intervention.
2. Financial Responsibility and Assignment of Benefits I authorize Achieving Abilities, LLC. to bill my health insurance provider directly for ABA services rendered. I understand that while the clinic will assist in verifying benefits, I am ultimately and fully financially responsible for any copayments, coinsurance, deductibles, or services that are denied or not covered by my insurance policy.
3. Affirmation of Legal Authority I reaffirm, under penalty of perjury, that I possess the active legal authority to authorize medical, behavioral, and educational services for this child based on the current custody decree or guardianship order provided. I agree that if my custody arrangement, guardianship status, or legal decision-making authority changes at any time, I will notify Achieving Abilities, LLC. in writing immediately and provide the updated, court-stamped documentation.
4. Voluntary Participation and Right to Revoke I understand that participation in ABA therapy is entirely voluntary. I hold the right to revoke this consent and discontinue services at any time by providing written notice to the clinic. I understand that revoking consent will not clear any outstanding financial balances incurred prior to the date of termination.
Frequently Asked Questions (FAQs)
If your decree states you share joint legal custody without a "tie-breaker" clause, both parents may need to consent to medical services depending on the exact wording of your agreement. Please upload your decree, and our team will review it. If both signatures are required, we will send a separate consent link to the other parent.