Service Provider Forms

Parental Verification of Receipt of Services


Section 4681.31 of the Welfare and Institutions Code requires any vendor who provides  services as specified below to submit verification to the regional center for services provided to consumers who are under 18 years of age and residing in the family home.

The Department of Developmental Services has developed a standard form for vendors to complete and provide to the family for signature. 

This requirement applies to most Behavioral Services

Download Forms for Behavior Intervention

Parental Verification Form

Individual Direct Service Log PDF

Individual Direct Service Log Word

Group Service Log PDF

Group Service Log Word