Diagnosis Service

You can proceed to register after reading and agreeing to the terms and conditions below:
The Center for Autism Research (CFAR) at King Faisal Specialist Hospital and Research Centre (Gen. Org.) (KFSH&RC) is a non-profit center, under the sponsorship and support of Riyadh Bank, offering diagnostic and clinical services for individuals with Autism Spectrum Disorders (ASD) and their families; training programs for professionals working with the ASD population; these services are provided under the research framework to advance the understanding of ASD and effective ASD interventions.

This Consent provides the Important Information under which I am agreeing to services (consultation, evaluation, etc.) I seek from the Center for Autism Research. I am requesting services from CFAR for

I have the authority to consent to the services, I being:

• his/her parent.
• his/her legal guardian. Please include a copy of the guardianship papers.
• legally responsible for myself and seeking services for myself.

B. Explanation of Consent

• I understand that in order for services to be completed by CFAR, I must consent to the services and in case of rejection, no services will be provided.
• I understand that my consent is completely voluntary and can be withdrawn at any time, and in case of withdrawal the services will be terminated immediately.
• I may withdraw my consent at any time in writing addressed to CFAR. However, I understand and agree that the consent cannot be withdrawn for any action previously taken, based on this consent.
• I understand that any information gathered before, during, and after services will be treated as confidential information by CFAR.
• I understand that it is my right to get copies of any reports generated by CFAR, if applicable. I also understand that I will be provided with copies as soon as possible after the services are provided by CFAR, if applicable.
• I understand a photocopy of this form will have the same effect as the original.
• I understand staff from CFAR may use electronic means (including but not limited to email, fax, etc.) to communicate with me and gather information for the services I have requested.
• I understand that a major focus of CFAR is the education of families. In response, I give CFAR permission to contact me regarding any upcoming educational events (family training, workshops, lectures, etc.), or other activities related to family involvement.

‌C. The Participation of CFAR Trainees and University Students:

• I understand that a major focus of CFAR is the training of students and professionals working with individuals with ASD, in order to increase the number of professionals who are trained to evaluate and assist people with ASD.
• I understand that all students and trainees who are involved in training at CFAR has signed a confidentiality agreement with CFAR.
• I understand that all students/trainees work under the supervision of a CFAR staff member or a University that has a valid Memorandum of Understanding (MOU) with CFAR.
• As part of my consent, I agree that students or trainees may participate in the services requested. They may either observe, directly evaluate, or both; and may participate in the case management activities during the course of service utilization.
• I understand that, when assigned by CFAR staff, students or trainees may review clinical records, both prior to and after services, including reports generated by CFAR.

‌D. Videotaping of Sessions:

• I understand that the services conducted by CFAR are videotaped. Videotaped sessions are reviewed by the clinical team as part of the clinical evaluation and services, for quality management of services provided and for supervision and training of students and trainees.

‌‌E. (Voluntary: will be checked manually on the first visit) Permission to Use Videotaped Sessions in Lectures, Workshops and Training Programs:

• I understand that as part of CFAR’s focus on providing training and education programs about ASD, CFAR staff may use videotaped session recordings during lectures, workshops, or for other CFAR training programs. No personal or identifying information shall be provided with the videotaped recordings when used for these purposes to maintain my confidentiality. By consenting to the use of my child’s videotaped session recordings, I will be supporting CFAR’s professional training programs aimed at increasing the numbers of skilled professionals available for individuals with ASD and improving the standard of ASD services in KSA.
• I understand that if I do not consent to videotaped session recordings to be used in lectures, workshops, and training programs, I will still be eligible to receive services at CFAR.

F. Use of Non-Identifying Information for Research:

• I understand that information collected during my contact with CFAR may be used for research purposes CFAR. I understand that any information will be presented as percentages, averages, or in other forms that will make it impossible for my child, myself, or my family to be identified. This information will be used to improve resources and services for people with ASD.

‌G. (Voluntary: will be checked manually on the first visit) Permission to Contact you to Obtain Additional Information for a Research:

• I would like to participate in CFAR future research concerning ASD. I agree to be personally contacted by CFAR for future research studies which may be seeking to recruit study participants.

‌H. Consent for Services:

• My consent is given freely and without coercion.
• I have been able to discuss any questions or concerns about this Informed Consent form with a staff member at CFAR. This person has answered any questions I had to my satisfaction.
• I understand that I may contact CFAR during the official working hours at telephone number: 011 557 6617 either to withdraw this consent or to ask further questions I may have.
• I accept responsibility for all charges associated with the Hospital services, after being informed about the cost of the service, which is not provided free of charge as per Hospital policy.
• I agree that the authorized competent judicial authorities and Saudi Arabia’s Courts will decide any dispute in connection with such accounts.

‌I. Disclaimers:

• Nothing in this form should be read to obligate CFAR to provide services.
• Services are scheduled and completed based on the clinical judgement of CFAR staff and using standardized ASD and developmental screening and assessment tools. These decisions are based on the appropriateness of the services in meeting the mission of CFAR and the appropriateness of the services in assisting the individual.
• CFAR reserves the right to refuse to provide services if the clinical staff determines that the services cannot be conducted appropriately at CFAR. In this case, CFAR staff will attempt to find another source of services, if applicable.
• I hereby release CFAR from all legal responsibility and liability that may arise from the acts I have authorized above.