New Client Information Form

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Updated: 6/2/25
We have upcoming openings at our CLINIC in Norcross (3091 Holcomb Bridge Rd, Ste N1) for mornings or all day therapy slots.

We have a waitlist for in-home services.

Please complete the following form if you would like to get started or to be added to our in-home waiting list. We will contact you with the next steps as soon as possible.

Email *

I would like to receive emails from Trusty Behavioral Services including newsletters and useful information. I understand my email will not be shared with any third-parties.

Service Location Preference: *

In Home Therapy (All ages)

At our Clinic (3091 Holcomb Bridge Rd, Ste N1 Norcross, GA...Ages 12 and under only)

Required

Before completing this form, please CAREFULLY read the following statement and acknowledge if you are in agreement. *

I understand that Trusty Behavioral Services provides Applied Behavior Analysis (ABA) therapy both in-home (across metro Atlanta) and in-clinic (at 3091 Holcomb Bridge Rd, Ste N1, Norcross, GA). Sometimes we are also able to deliver services in your child's daycare (if permitted), and/or in other community settings if treatment dictates. We schedule therapy sessions Monday through Friday between 9am-6pm. Therapy is NOT provided on the weekends or after 6pm on weekdays.

After completion of a comprehensive assessment, a treatment plan is developed that includes a recommended amount of treatment that generally ranges from 10 to 30 hours of therapy per week (typically 3-5 days/week). Patients must minimally meet at least 80% of the recommended weekly treatment hours to remain in the program. If all of the details above are agreeable, please mark acknowledge and continue. If the location, time, or amount of treatment don't work for you then unfortunately we will not be able to help.

I acknowledge

Please select ALL times that your child could be available to receive therapy. Keep in mind the average child needs between 3-5 days and 10-30 hours of therapy per week.

9:00am-12:00pm

1:00pm-3:00pm

1:00pm-5:00pm

3:30pm-6:00pm

4:00pm-6:00pm

Monday

Tuesday

Wednesday

Thursday

Friday

Are there any additional considerations we need to know when scheduling therapy?

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