Home applied behavior analysis sessions Specialized competencies Confidentiality and privacy Supervision and follow-up The service is currently available in Riyadh Jeddah Dammam Al Khobar Makkah Submit the application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Test the package *First package: 12 sessions (each session lasts an hour and a half) at a price of 2880 riyalsSecond package: 20 sessions (each session lasts an hour and a half) at a price of 3995 riyalsاختر الباقة *الباقة الأولى - 12 جلسةالباقة الثانية - 24 جلسةCustomer's full name *اسم المستفيد المباشر من الخدمة " المشخص بالاضطراب النمائي"Gender *malefeminineClient's date of birth (in Gregorian) *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Nationality *City *RiyadhEastern ProvinceJeddahمكة المكرمةبريدة/عنيزةالأحساءالمدينة المنورةأبها/خميس مشيطالطائفThis service is available in some cities in the Kingdom of Saudi ArabiaNeighborhood/street *Accommodation type *apartmentvillaIs there a place for client training? *YesnoWho does the client live with? *Example: Muhammad, 40 years old, father. Aisha 35 years old mother, Khaled, 22 years old Maryam, 18 years old.The relationship of the guardian responsible for communicating with the clientdadMotherbrothersisterOtherMention your relationship with the clientWhat language is used in the client environment? *The full name of the guardian responsible for communication *هل أحد الوالدين من منسوبي شركة أرامكو السعودية؟ *نعملاE-mail *Mobile number *Does the client have a medical diagnosis? *YesnoType of diagnosis *Autism spectrum disorderHyperactivity and distractionIntellectual disabilityDown's syndromeOther than thatState the type of diagnosis *Date of diagnosis *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Place of diagnosis *Attach the diagnostic report Click or drag files to this area to upload. You can upload up to 3 files. Maximum 3 files The customer's primary method of communication *SpeakerHe says some wordsNon-speakingCommunicates by exchanging pictures PECSDoes the client have health problems? *Yesnomention it *Is the client taking any medications? *YesnoWrite down the medications the client is taking, along with the dosage of each medication *Has the client previously received rehabilitative or educational services? *YesnoPlease write the rehabilitative and educational services that the child received, along with the duration and location of each service, for example: Behavioral sessions at the Seven Dimensions Center for 3 months *Does the client have undesirable behaviors such as (screaming, hitting...)? *YesnoMention the client's behavioral problems *Does the client have any allergies to specific foods? *Yesno Mention 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: Improve communication skills? *Field #89 (copy)أقر أنا الموضحة بياناتي أعلاه أني موافقـ/ـة على التقاط صور وإجراء تسجيل فيديو لكامل جلسات تحليل السلوك التطبيقي المقدمة أو أجزاء منها من فريق مركز الأبعاد السبعة ويحق لمقدم الخدمة والفريق الإشرافي والإداري الإطلاع عليها. *I the undersigned, acknowledge that I have read and agree to the terms and conditionsالتوقيع الرقمي * Clear Signature Send the request
