Behavioral Intervention Consent Form

Behavioral interventions are necessary when the behavior of an individual is not right and the organization wants to modify it through its intervention. People who want an individual’s behavior to be changed often seek help from a third party, whom they hope can help them successfully modify their attitude.

When should I use a behavioral intervention consent form?

Different institutes often require this form to be filled out, such as schools, hospitals, etc. However, in the majority of cases, the form is used by a healthcare facility when they come to know that they will have to deal with a person who is either a minor or someone who is legally or medically incompetent to decide whether he needs intervention or not. These types of interventions usually become a main part of the medical treatment a person is getting from a hospital.

Who can fill out this consent form?

It is important to remember that not everyone is capable of filling out this form and giving authorization. Only those people who have the power to allow the medical facility to intervene can fill out this form. In the case of a minor, parents are responsible for giving or refusing to give the authorization. In the case of elderly people, it is often the caregiver of children who has to fill out this form and take the responsibility of giving consent.

The organization collecting the permissions should check thoroughly who is allowed to permit because if they don’t take this seriously, they might put themselves in trouble.

Behavioral Intervention Consent Form

Sample Form File: 79 KB

How do I use the intervention form?

This form of authorization should be used systematically so that no one can say that the healthcare facility is using it to its advantage. The healthcare facility should keep this fact in mind: people who have their patient or client in their custody can choose to give permission or refuse it depending on what they find suitable. It is also important to keep in mind that they cannot force anyone to give consent.

If the custodian tries to revoke the permission at any given stage, the organization will have to stop the intervention as per the law. If doctors or professionals feel that the custodians should consent to better treatment of the client, they can try to convince them. However, they cannot force them, and the final decision is always in the hands of the custodians.

What information does the invention form for modifying behavior include?

The most important information that you can see in this form includes:

Consent statement:

At the beginning of the form, the authorizer gives consent and also mentions the purpose for which the intervention of the doctor is allowed. This section is usually followed by another section that collects the information of the authorizer, including his name, contact details, relationship with the client, and much more. It depends on the healthcare facility which details it should take from the authorizer.

Description of the process:

The form should briefly explain the entire process of intervention, including assessment, treatment, and much more. The parents or guardians of the clients are advised to read this form carefully so that they can understand what they should expect after they have authorized the professional doctors to intervene and change the behavior of the person that they don’t find right and want to be corrected.


The client as well as the parents, guardians, or caregivers should also sign the form, and then it should be submitted. At the end of the form, there are all the terms and conditions that clearly state what clients and their families should expect after they authorize the hospital to intervene.

In addition, the last part of the form also mentions the rights of the clients. Clients or patients should be aware of their rights so that no hospital or doctor can exploit them. If the section regarding rights is missing from the form, they should first request to read the rights section, and after reading and understanding it properly, they should decide whether to sign the form. The hospital should also make sure that the form is comprehensive and concise at the same time.

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