Forms
Before completing any forms, prospective clients should:
After you have called the office and billing service, please do the following:
- Call our office at 770.939.3073 to learn about our services.
- If we are a “good fit” for your needs and times are available, call our billing service at 800.789.5761, ext. 106 to get information about insurance as well as the self-pay option.
After you have called the office and billing service, please do the following:
- Download and complete the appropriate Form Packet linked below for either an Adult (18 years of age or older) or Child (17 years of age or younger), depending on the age of the patient.
- Note: These forms may be opened and typed into directly on your computer or other device. We have found that the best web browsers for filling out the forms online are Google Chrome and Firefox. You may open and save the forms as a PDF file using Adobe Acrobat Reader DC.
- Return the completed forms by attaching them to an email sent to our office: [email protected].
- Other ways to return the forms: Forms can also be attached to a message filled out and submitted on this website’s Contact Us page. Another option is to print out the forms, fill them out by hand and fax them to the office at 770.939.3275 or mailed to 3580 Habersham at Northlake, Tucker, GA 30084.
Adult Patient Information Forms Packet contains:
- Outpatient Services Contract
- Authorizatiosn and Notification Form
- Informed Consent Form for TeleHealth Services
- Telehealth Supplemental Information
- Adult Patient Information
| Adult Patient Information Forms Packet |
Child and Adolescent Information Forms Packet contains:
- Outpatient Services Contract
- Authorizatiosn and Notification Form
- Informed Consent Form for TeleHealth Services
- Telehealth Supplemental Information
- Child and Adolescent Patient Information
| Child and Adolescent Patient Information Forms Packet |