EBS Clubhouse Forms

Please use the following forms to submit information to EBS Clubhouse.  You can either fill it out online or download and print the PDF and bring it to us.  If you choose to fill out a form online, please know that we take your security and privacy very seriously.  Online forms are hosted on EBS's secure, HIPAA-compliant server.  Please call or email us if you have any questions.


Telehealth Informed Consent

ABA / Behavior

ABA Intake Form &
Parent Handbook

Specialized Programs

Orofacial Myofunctional Client Intake

Literacy Program Patient Payment Responsibility

Additional Forms

Request an Evaluation

Informed Consent

Policies and Procedures


Email Medical Records Liability Release

Health Policy &
Emergency Protocol

Release of Medical Information

Patient Payment Responsibility

Cancellation, Illness, HIPAA & Insurance Change Policy

Photography &
Video Release

Caregiver Request to Photograph