Connect Plus Therapy

Telehealth Waiver Form

 

Telehealth Waiver

In an effort to continue to provide our clients with the support Connect Plus Therapy now offers a Telehealth option. Should you wish to utilize this option you must read the below requirements and sign the agreement.
  • As the Parent/ Guardian, I would like to utilizetelehealth services through Connect Plus Therapy to continue to receive ABA services for my child. If he/she can no longer be safely managed through distance technology, I am aware that I can request for this service to either be modified or discontinued.
  • Date Format: MM slash DD slash YYYY