The Following Information is Needed Prior to Your First Visit:

PHONE (678) 619-0178

FAX (678) 550-9974

 1.  Case History Form (Which can be filled out and mailed online)

2.  Authorization for the Release of Medical Records (Included in online case    history form)

3.  Acknowledgement of the Receipt of Privacy Policy

4.  Consent to Bill and Consent to Treat (Included in online form)

5.  A PRESCRIPTION from the primary care physician with a Diagnosis Code

6.  A PHOTOCOPY OF YOUR INSURANCE CARDS (front and back)

 Any prior therapy notes, evaluations and/or medical information that will assist us in treating your child.

Please fill out the online intake form or fax the information to 678-550-9974.  If you have any questions please call (678) 619-0178.  

Intake Forms

• Intake Form 
• Consent to Treat and Bill
• Patient Privacy Form
• Authorization to Release Information