Schedule an ADOS

ADOS

The ADOS-2 assessment is the Autism Diagnostic Observation Schedule, authored by Catherine Lord, Ph.D., Michael Rutter, MD, et al., and published by WPS. It is a semi-structured, standardized assessment instrument that includes a number of play-based activities designed to obtain information in the areas of communication, reciprocal social interactions, and restricted and repetitive behaviors associated with a diagnosis of ASD. The ADOS-2 allows you to accurately assess and diagnose autism spectrum disorders across age, development level, and language skills. The ADOS-2 provides a highly accurate picture of current symptoms, unaffected by language. It can be used to evaluate almost anyone suspected of having ASD-from 1-year-olds with no speech to adults who are verbally fluent.

Required Forms

All ADOS’s completed in English and there is no age limitation (age 1 to adulthood)

Schedule your ADOS appointment today with us! Our user-friendly interface allows individuals to easily fill out all of the required forms online, eliminating the hassle of paperwork on the day of their appointment.

Please fill out all 3 forms online. After completing the last form, a calendar will conveniently allow you to shedule a ADOS. There is a $25 fee to hold your appointment that you pay online at the calendar stage. This is a down payment that will go towards your total bill.

Please bring a form of payment at the tentative date of your service. Payment is not allowed to be covered by your insurance provider and is a fee of $300 with credit card fees if applicable.

Rest assured, our state-of-the-art security measures prioritize the protection of personal information, creating a safe and efficient experience for all.

Informed Consent for Financial Responsibility & Testing Services

Introduction

Welcome to Autism Services of FL. Please take a moment to read through this important information. It is intended to inform you of the conditions regarding the testing services you are requesting. It is our policy to clarify all financial matters before services are rendered.

Financial Responsibility

I understand and agree that I will be charged a fee for all direct and indirect professional services rendered on my behalf. The standard rate for testing and generating the report is $300. We accept cash, check, and credit/debit cards. There is a credit card processing fee associated with all credit/debit card transactions. AUTISM SERVICES OF FL DO NOT ACCEPT ANY INSURANCE. More limited or extended services will be billed on a prorated basis if needed. These instances will be discussed and agreed upon with you before the services are rendered.

Initial for Financial Responsibility(Required)

Cancellations

Autism Services of FL requires a 24-hour notice for appointment cancellations. If you are cancelling without a 24-hour notice you will be charged a $25 cancellation fee. Another deposit will be required when scheduling another appointment for services.

Initial for Cancellations(Required)

Limitations of Services

Autism Services of FL provides testing with Autism Diagnostic Observation Schedule only. Autism Services of FL does not provide emergency services or any other services. Should you require emergency services after hours, please dial 911.

Assumptions of Risks

I understand that the potential risks may include possible disagreement with opinions offered to me, and possibly emotional distress concerning my situation. I understand that alternative procedures include services provided by another psychologist, psychiatrist, doctor, or mental health professional. I understand that while the evaluation will be based on the ADOS Test; it is not an exact science. I acknowledge that no guarantees have been made to me concerning the results of the evaluation of Autism Services of FL.

Acknowledgment of Responsibility

Full payment is required at the time of service. In lieu of this, you will guarantee full payment with a credit card along with the transaction fee associated with each charge. AUTISM SERVICES OF FL DO NOT ACCEPT ANY INSURANCE.

Initial for Acknowledgment of Responsibility(Required)

Release of Information

Utilization reviews may require the release of written or verbal confidential information such as notes, reports, test results, and questionnaires. You are directing Autism Services of FL to exchange information regarding your case, including the release of an ADOS report results to agencies, doctors, therapists, or to anyone you authorize in writing. By authorizing the release of information, I understand that I am waiving the confidential nature of the patient-analyst relationship. I also authorize the release of information as necessary for the purpose of Autism Services of FL obtaining consultation regarding my evaluation. I authorize the release of any and all information requested by my insurance carrier for the purpose of processing my insurance claim and obtaining payment for services. In authorizing the release of information to any insurance company or other third parties, I understand that the information may become part of the third parties’ records and that Autism Service of FL can no longer control any subsequent release of information. The only way you can absolutely assure the confidentiality of your treatment is to pay for the services yourself.

Limits of Confidentiality

I understand and agree that my disclosures and communications are considered privileged and confidential, except to the extent that I authorize a release of information. I understand that state law requires an analyst to disclose the following without consent or authorization:

Known or reasonably suspected abuse or harmful neglect of children, the elderly, or disabled or incompetent individuals.
Immediate threats of physical violence against a readily identifiable victim.
An immediate threat of self-inflicted damage.
Also, where a patient or client, by alleging mental or emotional damages in litigation, puts his or her mental state at issue or files a malpractice claim, records may be released without consent or authorization. Where a patient is examined pursuant to a court order, confidentiality may not apply. Under such circumstances, I acknowledge that I hold Autism Services of FL harmless for releasing information under any of the above conditions.

Statement of Understanding

I certify that I have read this form or that it has been read and explained to me in terms of my understanding. My questions have been answered to my satisfaction and all statements which I do not approve of have been stricken by mutual agreement. I understand I may revoke this consent at any time except to the extent that action has been taken in reliance upon it. I understand that my consent for the release of information will be considered valid for twelve (12) months after my last appointment. I acknowledge that I voluntarily consent to the preceding conditions. By signing this form, I understand and agree with the terms and conditions of this form.

Name of Patient(Required)

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Date(Required)

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Signature of Adult Patient or Parent/Guardian of Patient(Required)

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Contact Us

Phone: 239-349-3139
Fax: 239-984-4372
[email protected]

12501 World Plaza Lane, Building 51
Fort Myers, FL, 33907