New Day ABA Therapy, LLC  Intake Form updated 4.2025 Logo
  • Welcome!

  • Thank you for choosing New Day ABA Therapy! We are looking forward to assiting your family in meeting your goals. 

     

    Our Mission

    Cultivating compassionate ABA providers who celebrate neurodiversity! We will meet clients and families where they are and help them reach the goals that matter to them. 

    Our Vision

    To be recognized as supporters of individuals with differing needs to achieve self-determination and become their authentic selves. 

    Our Values

    Compassionate Care, Joy, Relationships, Personal Growth, Cultural Humility, Dependability.

     

    Client Rights

     As a client receiving services from New Day ABA Therapy, you have the following rights:

    The right to privacy and confidentiality: unless express permission is given for clinical purposes, you will not be photographed or recorded
    Cultural competence: Your cultural and religious identity and practices will be respected and incorporated into all aspects of your treatment planning
    Freedom from physical and psychological abuse and neglect
    Treatment modalties that are the least restrictive and most effective to meet the your goals
    Participation in treatment planning and implementation
    Personal dignity and safety
    The ability to refuse treatment and terminate the therapeutic relationship
    Receive communication in a form that is preferred by you
    Have access to both internal and external grievance procedures
     

     

  • What to Expect from ABA Therapy

  • What is ABA?

    Applied Behavior Analysis (ABA) is a scientific approach to understanding behavior. ABA refers to a set of principles that focus on how behaviors change, or are affected by the environment, as well as how learning takes place. The term behavior refers to skills and actions needed to talk, play, and live. While these principles impact everyone each day, they can be applied systematically through interventions to help individuals learn and apply new skills in their daily lives.

    ABA requires the implementation of established principles of learning, behavioral strategies, and environmental modifications to improve and teach new behaviors. In practice, implementation must be systematic so teachers can identify how behavior can be changed and understand how learning occurred. The ultimate goal of ABA is to establish and enhance socially important behaviors. Such behaviors can include academic, social, communication, and daily living skills; essentially, any skill that will enhance the independence and/or quality of life for the individual.

    Assessment/Starting Therapy

    Upon completing intake paperwork, an authorization for assessment will be obtained from your insurance company. The assessment will be conducted by a clinical lead, sometimes with the assistance of a program implementer. The assessment includes a parental interview, developmental assessment, functional behavior assessment (FBA) and skills assessment. The assessment will include at the minumum, a one hour observation. Once the in person observations have been completed, the clinical lead will analyze the assessment results and develop your child's individualized treatment plan (ITP) within 10 business days. The ITP will be reviewed with you and final therapy schdedule will be determined. Your child's ITP will be submitted to your insurance company and once we receive an authorization for ongoing services, the clinical director will contact your family to finalize the schedule and determine a start date for services. 

    Recommended Therapy Hours

    Your clinical supervisor will recommend a dosage of therapy hours following the assessment based on medical necessity. These are the hours necessary to make progress on the goals you have indicated as well as work on deficits identified in the assessment. We are ethically bound (BACB Ethics Code 2.0) to provide effective treatment. As such, we require families to be able to fullfill at least 80% of the recommended hours in order to move forward with services. 

    Ongoing Therapy

    Your plan implementer will work 1:1 with your child during all scheduled therapy sessions. The clinical lead will supervise for a minumum of 10% of the approved direct hours weeky. Example, your child is approved for 30 direct hours per week, so the clincal lead will observe sessions for 3 hours per week minimum. The clinical lead may observe session in person or through telehealth based on clinical need and the requirements of your insurance company.

    Your child's ITP will be updated every 3-6 months depending on clincial need and the requirements of your insurance company. It is our policy that all families meet with their clinical team quarterly to formally review program goals and client progresss.

    How long will therapy last?

    Every child has different needs and learns at a different rate. It is impossible to predict how long your child may continue to meet medical necessity criteria for ABA therapy. However, children typically receive ABA therapy for 1-3 years. 

    Session Observation

    Parents are encouraged to observe sessions. If your child is receiving center based services, we ask that you give 24 hours notice that you would like to observe your child's therapy. This gives your clincal lead time to ensure they can review the aspects of your child's program that you are most interested to observe and ensure that your observation is not disruptive of any other children receiving therapy at that time. If your child is receiving in home therapy, you are welcome to observe at any time, we just ask that you not disrupt your child's therapy services. 

    Communication

    Your child's program implementer will review how session went with you each day, highlighting the areas of focus and how your child responded. Your program implementer will not be able to answer detailed clinical questions about your child's ITP, as this is not their areas of expertise. We ask that these questions be communicated to your child's clincial lead. You are welcome to discuss your child's ITP with your clinical lead at any time, just reach out and schedule a time to meet with them and they will be happy to answer any of your questions!

     

  • I understand the information explained above and I understand that my child will need to be available to fulfill at least 80% of the recommended therapy hours in order to move forward with services.

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  • Client Intake Form

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  • Privacy Practices

  • When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.


    Get an electronic or paper copy of your record


    • You can ask to see or get an electronic or paper copy of your medical record
    and other health information we have about you. Ask us how to do this.
    • We will provide a copy or a summary of your health information, usually
    within 30 days of your request. We may charge a reasonable, cost-based fee.

    Ask us to correct your medical record


    • You can ask us to correct health information about you that you think is
    incorrect or incomplete. Ask us how to do this.
    • We may say “no” to your request, but we’ll tell you why in writing within
    60 days.


    Request confidential communications


    • You can ask us to contact you in a specific way (for example, home or office
    phone) or to send mail to a different address.
    • We will say “yes” to all reasonable requests.

    Ask us to limit what we use or share


    • You can ask us not to use or share certain health information for treatment,
    payment, or our operations.
    • We are not required to agree to your request, and we may say “no” if it
    would affect your care.
    • If you pay for a service or health care item out-of-pocket in full, you can
    ask us not to share that information for the purpose of payment or our
    operations with your health insurer.
    • We will say “yes” unless a law requires us to share that information.

    Get a list of those with whom we’ve shared information


    • You can ask for a list (accounting) of the times we’ve shared your health
    information for six years prior to the date you ask, who we shared it with,
    and why.
    • We will include all the disclosures except for those about treatment,
    payment, and health care operations, and certain other disclosures (such as
    any you asked us to make). We’ll provide one accounting a year for free but
    will charge a reasonable, cost-based fee if you ask for another one within
    12 months.


    Get a copy of this privacy notice
    • You can ask for a paper copy of this notice at any time, even if you have
    agreed to receive the notice electronically. We will provide you with a paper
    copy promptly.


    Choose someone to act for you
    • If you have given someone medical power of attorney or if someone is your
    legal guardian, that person can exercise your rights and make choices about
    your health information.
    • We will make sure the person has this authority and can act for you before
    we take any action.


    File a complaint if you feel your rights are violated
    • You can complain if you feel we have violated your rights by contacting us
    using the information on page 1.
    • You can file a complaint with the U.S. Department of Health and Human
    Services Office for Civil Rights by sending a letter to 200 Independence
    Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting
    www.hhs.gov/ocr/privacy/hipaa/complaints/.
    • We will not retaliate against you for filing a complaint.

    For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us.

    Tell us what you want us to do, and we will follow your instructions.

    In these cases, you have both the right and choice to tell us to:
    • Share information with your family, close friends, or others involved in
    your care
    • Share information in a disaster relief situation
    • Include your information in a hospital directory
    • Contact you for fundraising efforts


    If you are not able to tell us your preference, for example if you are
    unconscious, we may go ahead and share your information if we believe it is
    in your best interest. We may also share your information when needed to
    lessen a serious and imminent threat to health or safety.

    In these cases we never share your information unless you give us written permission:


    • Marketing purposes
    • Sale of your information
    • Most sharing of psychotherapy notes

     

    How do we typically use or share your health information? We typically use or share your health information in the following ways.


    Treat you

    • We can use your health information and
    share it with other professionals who are
    treating you.
    Example: A doctor treating you
    for an injury asks another doctor
    about your overall health condition.

    Run our organization
    • We can use and share your health information
    to run our practice, improve your care,
    and contact you when necessary.
    Example: We use health information
    about you to manage your treatment
    and services.

    Bill for your services
    • We can use and share your health information
    to bill and get payment from health plans or
    other entities.
    Example: We give information
    about you to your health insurance
    plan so it will pay for your services.

    Help with public health and safety issues
    • We can share health information about you for certain situations such as:
    • Preventing disease
    • Helping with product recalls
    • Reporting adverse reactions to medications• Reporting suspected abuse, neglect, or domestic violence
    • Preventing or reducing a serious threat to anyone’s health or safety


    Comply with the law

    • We will share information about you if state or federal laws require it,
    including with the Department of Health and Human Services if it wants to
    see that we’re complying with federal privacy law.

    Respond to lawsuits and legal actions
    • We can share health information about you in response to a court or
    administrative order, or in response to a subpoena.

    Our Responsibilities

    We are required by law to maintain the privacy and security of your protected health information.


    • We will let you know promptly if a breach occurs that may have compromised the privacy or security of
    your information.


    • We must follow the duties and privacy practices described in this notice and give you a copy of it.


    • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

    For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

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  • Informed Consent

  • I agree to have my child evaluated and treated by New Day ABA Therapy, LLC. I understand that these services are based on an Applied Behavior Analysis (ABA) model and will be provided by a professional trained in Applied Behavior Analysis and certified by the BACB as a Board Certified Behavior Analyst (BCBA), Board Certified assistant Behavior Analyst (BCaBA) and/or a Registered Behavior Technician (RBT).

    I understand that confidentiality may be broken under certain circumstances, particularly if your child is thought to be a danger to themselves or others. I understand that employees of New Day ABA Therapy, LLC are all mandated reporters. This means that any staff member is obligated to report any suspected neglect or abuse. 

    Your and your child have a right to be involved in the treatment planning process and to help prioritize the goals that will be addressed in therapy. 

    New Day ABA Therapy, LLC will utilize a variety of ABA techniques in your child's treatment. The treatment plan and goals will be reviewed with you and will be updated every 6 months at a minimum. Additionally, you will be asked to participate in quarterly program reviews and monthly parent training sessions. All families are required to attend 6 hours of parent training in the basics of ABA and what to expect from therapy before being assigned an RBT. 

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  • Authorization to Bill Insurance

  • I give my consent for New Day ABA Therapy, LLC to bill my/my child's insurance carrier for the services rendered to my child by the above-mentioned provider. I agree to pay New Day ABA Therapy, LLC any deductible or coninsurance in accordance with my health care plan. I agree to pay all collections cost and/or attorney's fees if any deliquent balance is placed with an agency or attorney for collection, suit or legal action. 

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  • Authorization to Release Medical Information to Insurance Carrier

  • I give my consent for New Day ABA, LLC to release medical and other relevant information to our insurance carrier as required to process medical claims and billing. I also authorize the sharing of necessary medical information in the event that my account is sent for collection or lawsuit.

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  • Clinical Intake Interview

  • Therapy Policies

  • Session Start Times, End Times and Cancellations

  • Consistent attendance at appointments is a vital component of effective ABA therapy service delivery. Families are encouraged to minimize vacations to no longer than one week at a time, no more than a couple times a year. If you need to miss a therapy session due to a vacation or medical appointment, please let your clinical lead know at least two weeks in advance. 

    If your child or another family member (when receiving home or community based services) are ill or you have a family emergency and need to cancel a session, please contact your clinical lead as soon as possible to let them know. If you are receiving in-home or community based services, you should also let your program implementer know that you need to cancel.

    Families who miss more than 15% of scheduled appointments without prior planning will be required to meet with the clinical director to discuss concerns and develop a plan to increase attendance.

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  • Health and Safety

  • COVID 19 Precautions/Illness

  • The health and safety of our learners and staff are of the utmost importance to us. We will be providing daily health screening upon arrival for the session including temperature checks and a short questionnaire related to Covid 19 symptoms. The staff members, learners, and family will all be administered the health assessment.

    We require staff, families and learners to wear facial coverings that conforms to CDC guidelines. If your child needs assistance tolerating wearing a mask, inform your clinical lead so that they can work on a tolerance program.

    Handwashing will occur at the beginning of each session, after toileting, before and after meals and after any contact with nose, eyes, or mouth. If handwashing is not immediately available, hand sanitizer will be available as an alternative.

    At this time, all staff are wearing facial coverings during therapy sessions. The client has the option to wear a facial covering, but it is not required.

    Learners should be in good health in order to attend therapy sessions each day. If your child has a fever of 100.4 or higher, has diarrhea (not caused by a documented medical condition) or has vomited in the last 24 hours, you should contact your clinical lead to cancel the session as soon as possible. 

    Additionally, if your child has been diagnosed with any of the following contagious conditions, they will need to be cleared by a medical professional before resuming therapy sessions.

    • Lice
    • Chicken Pox
    • Scabies
    • Conjunctivitis (Pink Eye)
    • Fifth Disease
    • Hand, Foot, and Mouth Disease
    • Whooping Cough
  • COVID 19 Vaccination Preference Survey

  • Medication Administration

  • It is preferred that prescribed medications be administered outside of therapy time by the caregiver. However, in some instances, medications may need to be administered during therapy time. In these cases, all medications must be in their original container with dosage size and times clearly indentfied by a medical practitioner. For over-the-counter (OTC) medications, dosing instructions can be provided in writing by the caregiver as long as it does not conflict with any instructions on the bottle. Caregivers will need to complete a medication administration consent form and a medication log will be completed each time medications are administered. Medications will be stored in a locked cabinet out of reach of learners and are only to be administered by a clinical lead or program lead. 

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  • Home and Community Based Services

  • Home and community based sessions can be a great way to work on functional skills in the environment in which they occur and to generalize skills to caregivers. Additionally, in home and community based services allow for more caregiver training and involvement. However, it is important to make sure that the environment is set up to accomodate therapy and is free of unnecessary distractions. Prior to beginning home or community based ABA therapy, your clinical lead will complete an environment safety checklist and review the expectations for home and community based therapy. The checklist will be updated every 6 months or anytime there is a change in the home environment (e.g. new family member moves in, family gets a pet, move to new residence or classroom)

    1) A parent or designated caregiver over the age of 18 must be present and available during the entire duration of the therapy session. Under no circumstances should a therapist be left alone with the learner. 

    2) Learners should be dressed and fed prior to their therapy appointment unless these are areas being addressed in the treatment plan.

    3) The environment should be clean, free of excessive items, debris, safety hazards or animal waste. 

    4) There should be a designated therapy area that includes a work surface (table, desk, etc.) and comfortable seating for the learner, the therapist and a supervisor or parent when needed. 

    5) Learner materials will be left in the home, so there should be designated storage area where the items will be kept safely so as not to be lost or incur damage.

    6) There must be a working bathroom at all times during therapy. There should be soap and paper towels available for handwashing during the session. If the learner is working on toilet training, there should be nitrile gloves, cleansing wipes, and diapers available for the therapist to use. If the child is not working on toilet training, the parent will be responsible for changing diapers/pull ups as needed.

    7) Meal and snack times will be agreed on prior to starting in-home therapy sessions and food should not be provided to the learner outside of the designated times so as not to interfere with therapy.

    8) First aid materials should be available during the session and the therapist and clinical lead should be made aware of the location. 

    9) Parents/guardians should refrain from interfering with sessions and should follow the lead of the therapist when addressing behaviors that have been identified in the treatment plan. Any concerns about treatment goals should be addressed with the clinical supervisor. 

    10) Your therapist and clinical lead will advise you on how to set up the environment to best promote therapy. This may include suggestions of putting some preferred items up on higher shelves or limiting access to certain items during therapy. It is our expectation that parents will be compliant with these suggestions but are welcome to express any concerns as therapy is a collaborative process. 

    11) Illness policies extend to any family members in the home. Sessions will need to be canceled if any family members display contagious illness. 

    12) A thermometer should be available to take the child's temperature prior to the beginning of session and at any time during session if a fever is suspected. 

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  • Parent Involvement

  • Parent training and involvement is a vital piece of the therapeutic process as it ensures generalization of skills to the parent and the home environment outside of therapy. We respect that parents have a busy schedule, however, we require parent training for a minimum of 1 hour per month. Your clinical lead may recommend more parent training if clinically indicated.

    If families miss two scheduled parent training meetings in a row, they will be required to attend a team meeting with their clinical lead and the clinical director prior to resuming services. 

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  • Filing Complaints or Grievances

  • We strive to provide the highest level of services to all our families, however, if you feel that you have been mistreated or have concerns about your child's therapy, we ask that you attempt a resolution with your clinical lead. If you cannot reach a resolution, you are welcome to file a formal complaint with our Clinical Director, Dawn Davis, PhD, BCBA (dawnhdavis@newdayaba.com) or by phone (404) 664-4118.

    If you have any concerns about BACB Ethical Violations, you can report them to the Ethics department at the following link: 

    https://www.bacb.com/ethics-information/reporting-to-ethics-department/

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