Informed Consent for Autism Assessment and Consultation
Julie Bjelland, LMFT | License #88019
Website: www.JulieBjelland.com
Updated: June 12, 2026
Understanding the Assessment and Consultation Process
Participating in an autism assessment or consultation can bring up many emotions. These services are designed to be compassionate, supportive, and neurodiversity-affirming. Many people find them to be meaningful steps toward clarity, self-understanding, and self-acceptance.
An autism assessment does not guarantee that a person will be identified as autistic. If additional support is desired after the assessment, consultation sessions may be available.
Consultation sessions provide autism-related education, support, and guidance related to sensitivity, neurodivergence, nervous system care, and related needs. Consultation sessions do not provide a diagnosis.
Consultation sessions are educational and supportive in nature and are not psychotherapy, crisis care, or ongoing clinical treatment. Participating in a consultation does not establish an ongoing psychotherapy relationship.
Scope of Services
Autism assessments evaluate autism only. The clinician has experience differentiating autism from ADHD, trauma-related patterns, anxiety, sensory processing differences, and other diagnoses, but this assessment is not a full evaluation for every possible diagnosis.
An autism assessment is based on written information, clinical interview, history, self-reflection, and professional judgment.
The accuracy and usefulness of the assessment depend in part on the completeness and accuracy of the information provided in the written questionnaires and clinical interview.
Consultation sessions may include education, support, reflection, and guidance, but they are not a substitute for a full autism assessment, psychotherapy, crisis care, medical care, or psychiatric care.
Services do not include medical care, medication management, psychiatric treatment, crisis intervention, or emergency monitoring. Please consult a physician, psychiatrist, therapist, or other appropriate professional for medical, psychiatric, therapy, or medication-related concerns.
If autism is identified through an autism assessment, a simple diagnostic letter is included at no additional cost. This letter confirms the diagnostic outcome but is not a comprehensive formal report.
The detailed Personalized Autism Profile Report is only included if that assessment option was selected at the time of booking or otherwise arranged. This report may include a more detailed summary of developmental patterns, sensory profile, masking, burnout, strengths, functional impact, and diagnostic rationale.
Clinical documentation and any included diagnostic letter or selected Personalized Autism Profile Report are completed after the assessment process and may require additional processing time.
Additional paperwork for a school, workplace, government agency, disability benefits, legal matter, or other organization may require an additional fee. Clients are responsible for confirming the specific documentation requirements of any outside organization before scheduling if they need documentation for accommodations, benefits, legal matters, school, work, or other formal purposes.
This assessment may not meet the requirements for every outside agency, school, workplace, legal matter, disability benefits process, or government program. If you need documentation for a specific purpose, please confirm those requirements with the outside organization before booking.
Telehealth Consent
Assessments and consultations take place by secure video. Telehealth can offer accessibility and convenience, and it also has possible risks, including technology problems, privacy interruptions, or limitations compared with in-person services.
By scheduling and participating in an assessment or consultation, you consent to participate by telehealth.
For autism assessments, California licensing requirements ask that you be physically present in California during the live video assessment session. You do not need to live in California. For paperwork purposes, a California address is required on the Client Information Form. A temporary California address, such as a hotel, friend/family address, or other temporary address, is acceptable. This requirement is about licensing and paperwork, not residency.
You agree to participate from a private location and to use a secure internet connection whenever possible.
Electronic Forms and Assessment Questionnaires
Written assessment questionnaires are an important part of the autism assessment and consultation process. These forms may include sensitive personal information and protected health information, including developmental history, mental health history, prior diagnoses, medications, sensory experiences, relationships, work or school functioning, and lived experience.
Please complete forms only through the links provided by this practice. Do not forward form links to others.
Electronic systems used in this practice are selected with privacy and confidentiality in mind. When outside companies or digital platforms may handle protected health information, reasonable efforts are made to use appropriate HIPAA-related privacy protections, including written privacy agreements when required.
No electronic form, communication method, or digital storage system can be guaranteed to be completely secure. Please do not submit assessment forms from a public computer, shared device, public Wi-Fi network, or any setting where your privacy may be compromised.
If you have concerns about using electronic forms, please contact me before submitting your information so we can discuss possible options.
Fees, Attendance, and Service Requirements
Autism assessments and consultations are paid out of pocket. Insurance companies are not billed, and fees will not apply toward any insurance deductible.
Clients are responsible for reviewing and following all payment, cancellation, refund, rescheduling, late-arrival, technology, and written-questionnaire policies before booking.
If you cancel or reschedule with at least 48 hours’ notice, you may reschedule one time at no additional cost.
If you cancel with at least 48 hours’ notice and do not want to reschedule, you will receive a refund minus a $75 administrative/payment processing fee. This fee helps cover credit card processing fees and administrative time.
If you cancel with less than 48 hours’ notice, 50% of the appointment fee will be refunded and 50% will be retained.
If you are 15 or more minutes late to the scheduled video session, the session may be considered forfeited. In this situation, 50% of the appointment fee will be refunded and 50% will be retained.
For autism assessments, the Written Autism Assessment Questions, Parts 1, 2, and 3, must be completed at least 48 hours before the scheduled video session. If the required written assessment questions are not completed on time, the appointment may be canceled according to this policy.
Please review this policy carefully before booking.
Confidentiality
All information shared during an assessment or consultation is confidential and will not be disclosed without written permission, except in situations required or permitted by law, including:
If there is a serious risk of harm to yourself or others
If there is suspected abuse or neglect of a child, dependent adult, or elder
If records are subpoenaed or required by court order
If disclosure is otherwise required or permitted by law
Please also review the HIPAA Notice of Privacy Practices for more information about how personal and health information may be collected, used, stored, and protected.
Communication Boundaries
Email and text communication may be used for scheduling, payment questions, form reminders, and other administrative or logistical matters.
Please avoid sending sensitive clinical information, detailed personal history, assessment responses, or urgent mental health concerns by regular email or text. Clinical information should be shared during sessions or through the assessment forms or other systems provided for that purpose.
Although reasonable safeguards are used, regular email and text messaging may not be fully secure. If you choose to send personal or health-related information by email or text, you understand there may be some privacy risk.
Julie is not available on call and does not provide crisis services, emergency services, or emergency monitoring. Messages are not monitored for emergencies.
In case of an emergency or mental health crisis, please go to your local emergency room, call 911, or contact a local crisis line.
Accessibility and Accommodations
Efforts will be made to provide an inclusive and supportive experience. If you need accommodations, such as sensory-friendly adjustments, communication support, pacing adjustments, or technical assistance, please communicate those needs in advance when possible.
HIPAA Notice of Privacy Practices
The HIPAA Notice of Privacy Practices explains how personal and health information may be collected, used, stored, and protected. It also explains privacy rights.
Please review the HIPAA Notice of Privacy Practices
Questions Before Scheduling
If you have questions about this consent before scheduling, please contact:
Julie Bjelland, LMFT
Consent
By scheduling and participating in an autism assessment or consultation with Julie Bjelland, LMFT, you confirm that you have had the opportunity to review this Informed Consent for Autism Assessment and Consultation, including the scope and limits of the service, and agree to proceed.
The most recent version of this consent will be available on this page.