Schedule Your Appointment

 

 

Client Forms

Please complete forms 48 business hours before your appointment. 

Thank you!

You will see the image below when you click on links to fill out paperwork.

The following forms are needed, prior to your first appointment:

  1. Confidential Client Info & Agreement
  2. Financial Agreement/ CC Auth Form (If someone else is paying for your sessions, they will also need to complete this form, put client name at top of form, and send a copy of their id).
  3. Tele-mental Health Informed Consent
  4. Notice of Privacy Practices
  5. Copy of driver’s license
  6. Copy of insurance card, front and back (if using insurance)

** Please send copy of driver’s license to us via email or fax**
(fax) 1-888-394-1986 or (email) info@healingpsychotherapyga.com

Additional Forms:
The below forms are dependent upon the service you are receving and some of the forms are for informational purposes. 

Sliding Scale Financial Agreement

Update Credit Card on File

Notice of Privacy Practices (complete document)

Release of Information

Contact Us.

We look forward to hearing from you!