Atlantis Positive Behavior Services Client Inquiry

Atlantis Positive Behavior Services Client Inquiry

Discovering the hidden potential
Atlantis PBS Mission:

Our overall mission is to enrich our community, our clients, client families, and employees through increasing independence and enabling growth by providing quality individualized ABA services. We work within the regulations and guidelines of the Department of Behavioral Health, the Behavior Analyst Certification Board, and your insurance provider.

Our vision is to increase the quality of life for all we serve. Our individualized services are always compassionate and empathetic as we look to meet our clients exactly where they are in life. We take time with each family, recognizing their wants and needs, barriers, experiences, and goals. Our ethical approach utilizes research-based ABA practices that our families will find reliable and transparent. Overall, we look to make a meaningful difference in our community.
Applied Behavior Analysis
What is ABA?

Set of principles based on the science of learning and behavior that form the basis for behavioral treatments. It is considered an evidence-based “best” practice treatment by the US Surgeon General and by the American Psychological Association. Behavior analysis helps us to understand how behavior works, how behavior is affected by the environment, and how learning takes place.
Overall objective of ABA:

Helps increase language and communication skills, improve attention, focus, social skills, memory, and academics, and decrease problem behaviors. Behavior analysis-based treatment has helped many individuals acquire skills that provide healthier lifestyles. ABA therapy involves many research-based approaches for understanding and changing behavior. A significant positive of ABA is that it is an adjustable treatment. It can and should be adapted to each person.
The following pieces are necessary for every client to achieve mutual outcomes:

-An environment for learning with few distractions.

-All involved to be committed and prepared for scheduled sessions.

-Intensive direct sessions with your child based on the BCBA supervisor's prescribed hours (12-30 hours per week).

-Parent/family/caregiver involvement and participation in basic ABA training.

-Pairing/collaborating with other medical services your child receives.

-An annual reassessment that includes the use of an extensive questionnaire.
Eligibility and Face Sheet Information
Client Full Name

First NameLast Name
Client Date of Birth

MonthDayYear
Date
Client's Gender
Does your child display any 2 of the following?
Please explain the behaviors displayed and/or of concern.
Client's Diagnosis

Other
When was the client diagnosed?
Caregiver Name

First NameLast Name
Caregiver Relationship to Client
Caregiver Phone Number
Format: (000) 000-0000.
Caregiver Email Address
example@example.com
Client Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Access to Wifi In the Home?

Availability for 2 - 5 hour sessions:

Rows	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Morning (8am - 12pm)
Afternoon (12pm - 4pm)
Evening (4pm - 8pm)

Notes on Availability
We hire and thoughtfully train team members who align with our mission to provide meaningful, compassionate, and value-driven ABA services and are a equal opportunity employer. What characteristics would best match your child's needs?
ie female/male/energetic/mellow/goofy/serious
Insurance

Other
Define Other Insurance
Upload Front of Insurance Card

Cancelof
Upload Back of Insurance Card

Cancelof
Primary Insurance Number
Secondary Insurance Number
Date of birth of Policy Holder
Case Worker Name

First NameLast Name
Client's School (N/A if client is not in school)
Home from school at approximately:

Hour Minutes

AM/PM Option
Client's Grade (N/A if client is not in school)
Client Classroom Type

Other
Client's Primary Care Physician
Client's Specialist Doctor
How did you hear about us?
Caregiver Name

First NameLast Name
Caregiver Signature
Should be Empty:

Atlantis Positive Behavior Services Client Inquiry

Applied Behavior Analysis

Eligibility and Face Sheet Information