Participate in Applied Behavior Analysis sessions at the center Specialized competencies confidentiality and privacy Supervision and follow-up Submit an application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Program type *Skills Development ProgramComprehensive Program (Skill Development and Reducing Behavioral Problems)The bouquet *First package (12 sessions)Package 2 (24 sessions)Customer's full name *Name of the direct beneficiary of the serviceSex *malefeminineCustomer's date of birth (Gregorian) *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Nationality *neighborhood/street *Who does the client live with? *Example: Mohammed is 40 years old, father, Aisha is 35 years old, mother, Khaled is 22 years old, Maryam is 18 years old. The relationship of the guardian responsible for communicating with the clientdadorbrothersisterOtherMention your relationship with the client.What language is used in the client environment? *Full name of the guardian responsible for communication *Is either parent an employee of Saudi Aramco? *Yesnoe-mail *Mobile number *Does the client have a medical diagnosis? *YesnoState the type of diagnosis *Primary customer communication method *SpeakerSay some wordsNon-speakingCommunicates by exchanging pictures PECSDoes the client have any health problems? *YesnoMention it *Is the client taking any medications? *YesnoWrite the medications the client is taking with the dosage of each medication. *Has the client previously received rehabilitation or educational services? *YesnoPlease write the rehabilitation and educational services the child received, along with the duration and location of each service. Example: Behavioral sessions at the Seven Dimensions Center for 3 months. *Does the client have unwanted behaviors such as (screaming, hitting...)? *YesnoMention the client's behavioral problems. *Does the client have any allergies to specific foods? *Yesno Mention the foods *Customer's favorite games *Minimum 5 favoritesCustomer's favorite foods *Minimum 5 favoritesWhat are your priorities for benefiting from applied behavior analysis services, for example: improving communication skills? *CheckboxesI, the person whose information is shown above, agree to the taking of photos and video recording of all or parts of the ABA sessions provided by the Seven Dimensions Center team. The service provider and the supervisory and administrative team have the right to review them to oversee the quality of the service, and they will not be used for any other purposes.Checkboxes (copy) *I, the undersigned, acknowledge that I have read and agree to the terms and conditions.digital signature * Clear Signature Submit application