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40 Southbridge St., Suite 202
Worcester, MA 01608

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To help us help you, please fill out the form below with as much detail as possible and submit via this website. An FTF consultant will contact you to collaboratively design a training and consultation package to help you achieve your goals and discuss timelines, fees, etc.

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40 Southbridge St., Suite 202
Worcester, MA 01608

Tell us how we can help you

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Basic Contact Information Fill out your basic contact information first
Organization Name*
Organization's Website
Your Name*
Title*
Your Location:*
Email Address*
Phone*

Describe the primary objectives of your organization that may be achieved from a relationship with FTF Behavioral:
Describe the populations your organization serves:
If you are seeking assistance with problem behavior, please describe the context(s) in which your staff address problem behavior (e.g., home, school, inpatient hospital, outpatient clinic, etc.) and the average and range of hours in which your staff have access to the children/clients served:
Of the following, which are the top priority areas you’d like to address with us? (Please select 1-2):
- Severe Problem Behavior: Self-injurious behavior (SIB), aggression, property destruction, motor or vocal disruptive behavior, meltdowns
- Other Dangerous Problem Behavior: Elopement, Pica
- Interfering Stereotypy: Motor, Object, or Vocal
- Sleep Problems: Routine noncompliance, delayed sleep onset, sleep interfering behavior, night awakenings, early awakenings, confusional arousals
- Eating Problems: Mealtime problem behavior, food selectivity, food refusal
- Problem Behavior Prevention
- Other
Please describe your answer below:
Are there any other areas you might like help with? (select all that are relevant):
- Severe Problem Behavior: Self-injurious behavior (SIB), aggression, property destruction, motor or vocal disruptive behavior, meltdowns
- Other Dangerous Problem Behavior: Elopement, Pica
- Interfering Stereotypy: Motor, Object, or Vocal
- Sleep Problems: Routine noncompliance, delayed sleep onset, sleep interfering behavior, night awakenings, early awakenings, confusional arousals
- Eating Problems: Mealtime problem behavior, food selectivity, food refusal
- Problem Behavior Prevention
- Other
Please describe your answer below:

If you are seeking in-person training, note whether you prefer the initial training to be:
- conducted in the area in which your company is located, or
- conducted in our office or venue in Worcester, MA
and whether you prefer the initial training to be:
- open to the community
- closed to your organization’s employees and/or families
Other information you would like to communicate relevant to the location of the training and attendees:
Please describe the type of implementation support you are seeking from this relationship (check all that apply)
- On-site consultation for severe problem behavior
- Distance consultation for severe problem behavior
- On-site consultation for sleep, eating issues, and/or prevention
- Distance consultation for sleep, eating issues, and/or prevention
- Systems/policy development
- Research program development
Other information you would like to communicate relevant to the way support is provided for implementing the assessment and treatment procedures:
Please provide any other information here that you feel is relevant to starting a collaborative relationship with FTF Behavioral:
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