Behavior Consult Request Form Your Name (required) Your Email (required) Your Address (required) Your Phone Number (required) Child's Name (required) Child's Age (required) Child's Likes/Dislikes (required) Is Your Child Living With Special Needs? (required) Concerns (required) Goals (required) Steps Already Taken (required) Additional Information Who may I thank for referring you? (Name, Email, Phone Number) By checking the box you agree to the following terms. Intuitive Behavioral and Educational Strategies, LLC is not responsible for the actions of clients. Intuitive Behavioral and Educational Strategies, LLC is not responsible for costs incurred or chosen by clients after being given recommendations or advice. Payment is due when services are rendered. 48 hours notice is required in order to cancel an appointment with no penalty fee. Cancelling with 24 hours notice requires 1/2 of the full payment. No shows are required to pay the entire fee. No refunds once the appointment has begun.