Contact 

Please feel free to contact me with any questions you may have or if you are interested in scheduling an appointment 

 

3116 Maple Drive
Atlanta
United States

678-699-0021

Paperwork

Required Forms

For all new clients, prior to your initial appointment, please complete and print the following online forms. If you are coming for couples or family counseling, each person should complete his or her own set of forms.  

There are five Required Forms (1-5)* total:
1)  Adult Client Information Form*
or
Child/Adolescent Client Information Form*

2)  Professional Disclosure Form*

3)  Data Sheet Form*

4) HIPAA Privacy Notice*

5) Cancellation Policy*

Optional Forms

The credit/debit card form is, of course, completely optional; please complete it if you would like us to keep your information on file to charge services for your convenience.
Credit/Debit Card Form (Optional)