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Important Forms

If you are a new Client, please complete the following forms and bring them to your first appointment.
NEW CLIENT FORMS

Intake Form

Intake
File Size: 1028 kb
File Type: pdf
Download File

Consent for
​Telemental Health

Consent-Telemental Health
File Size: 44 kb
File Type: pdf
Download File

Information & Agreement

Information & Agreement
File Size: 94 kb
File Type: pdf
Download File

If you would like Vickie to coordinate your counseling with any other professionals (such as a psychiatrist or other medical professional), please complete the Release of Information form.

Release of Information

Release of Info
File Size: 266 kb
File Type: pdf
Download File

THE NO SURPRISES ACT
If you are a new Client, please print and complete the following forms and bring them to your first appointment.

Good Faith Estimate

Good Faith Estimate
File Size: 210 kb
File Type: pdf
Download File

NEW CONSULTATION FORM

Consultation ​
​Agreement

Consult
File Size: 23 kb
File Type: pdf
Download File

NEW SUPERVISEE FORM
If you are a new Supervisee, please complete the following forms and bring them to your first appointment.

​Consent for Telemental Health Supervision

Contract and Agreement

Consent TMH Supervision
File Size: 45 kb
File Type: pdf
Download File

Contract & Agreement
File Size: 23 kb
File Type: pdf
Download File

Please contact Vickie for more information and to schedule an appointment.

Contact Vickie

Hours

M-F: 10am - 6pm

Telephone

770-813-8181

ADDRESS

1325 Satellite Blvd., NW, Bldg. 1000, Suite 1002
​Suwanee, GA   30024
Suwanee, GA 30024
  • Home
  • About
  • SERVICES
    • Counseling
    • Sex Therapy
    • Supervision
  • RESOURCES
    • What to Expect
    • Fees/Ins
    • Forms
    • RESOURCES
  • Blog
  • CONTACT
    • Directions