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Please upload a copy of your insurance card.Previous Treatments for Behavior Issues Speech Therapy ABA Medication Occupational Therapy Informal Behavior Treatment Other Description of TreatmentBehaviors of Concern (please select at least one) Physical Aggression (Harming, or attempting to harm, another individual) Self-Injurious Behaviors (Harming, or attempting to harm, self) Property Destruction (Destroying, or attempting to destroy, property) Elopement (Leaving, or attempting to leave, the supervised area) PICA (Ingesting, or attempting to ingest, inedible objects) Tantrum (Crying, screaming, yelling, throwing things, or falling to the floor) Verbal Aggression (Yelling, screaming, or cursing at another individual) Noncompliance (Not complying with necessary instructions) Other Description of BehaviorDescription of the behaviors, including frequency (daily, weekly, monthly) and intensity (severe, moderate, minor)
