attachment and bonding center of ohio

gregory c. keck phd

Application Checklist

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A complete application package is provided to help expedite the collection of information and the assessment process. If you wish to pursue the assessment process, please return all the requested material to ABC of Ohio. Include at the time submission of any other materials that you have, i.e., social history, adoption information, psychological/psychiatric treatment summaries, etc. You may print the entire application packet, along with the checklist and return the completed package with your fee of 110.00.

Please note -- Application materials should only be sent by mail or alternate delivery service. We do not utilize the Internet or Faxing for application processing. All phone calls will be returned promptly.

You will need to have the Adobe Acrobat Reader installed on your computer to view PDF files. Click the button to safely download this free program.

You can download the Full Application Package or you may download by section.

All of the following sections are required:

• Child Registration Form

• Financial Agreement

• Permission to Treat

• Attachment Symptoms for Children Under 5

• Attachment Symptoms for Children Over 5

Please return all completed application materials, the application fee ($110.00) payable to ABC of Ohio, and any additional case information. You will be contacted when a review of all information is complete.

Partial application packets will be held until all required material is received.

In preparation for the treatment of your child in this office, we are providing copies of two books with your paid application fee: "ADOPTING THE HURT CHILD" and "PARENTING THE HURT CHILD" by Gregory C. Keck, PhD, and Regina Kupecky, LSW,. These books will be referred to throughout the treatment process. You will be better prepared for the assessment and treatment process after reading them.

Upon receipt, all material will be reviewed and, if appropriate, you will be contacted to schedule the assessment. If there are issues that would be best treated by another approach at another setting, you will be informed at this time. The application package can be printed from the link provided below.

Adopting the
Hurt Child

Parenting the
Hurt Child

Gregory Keck
Regina M. Kupecky

Click covers
for details

Gregory Keck, PhD

Attachment and Bonding Center of Ohio

Cleveland Office  440-230-1960
12608 State Road
Suite 1
Cleveland, Ohio  44133

Columbus Office  614-850-9800
3966 Brown Park Drive
Suite H
Columbus, OH 43026

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