Patient confidentiality is a top priority at StarBright ABA. Therefore, it is important that you provide us with the following information to ensure there is no violation of your privacy.
In the event that I, First Name Last Name, am unable to be reached, StarBright ABA may leave information with the following:Other adult in household (Name): First Name Last Name On home answering machine(#): Area Code Phone Number On cell phone(#): Area Code Phone Number I may be reached at my work number: Area Code Phone Number May leave a message at my work number: Yes No Other (please describe): OPT OUT (initials) in the event that I am unable to be reached, StarBright ABA MAY NOT leave information with anyone but myself. I understand that if the status of any of the above information changes, it will be my responsibility to inform the staff at StarBright ABA.