Behavior Therapy Intake Form






  • Please answer the following questions regarding Aggression to Others.




  • Please answer the following questions regarding Self-Injury.




  • Please answer the following questions regarding Eating/Feeding Issues.




  • Please answer the following questions regarding Non-Compliance.




  • Please answer the following questions regarding Property Destruction.




  • Please answer the following questions regarding Escaping.




  • Please answer the following questions regarding Acting Out.