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Atlanta Therapy | Atlanta Forms | depression | counseling | Peachtree Psychological Associates | GA |

Peachtree Psychological Associates

2045 Peachtree Rd., Suite 150
Atlanta, GA 30309

404-352-4348

Forms

 

Please click on the appropriate text to download the forms you need.  Complete forms and bring them to your appointment.

Dr. King

New Therapy Client

1.         Client Information Form

            a.         Child Client

            b.         Adult Client

2.         Professional Services Agreement for Therapy

 

New Forensic/Custody Evaluation Clients

1.         Adult Client Information Form

2.         Informed Consent for  Forensic Evaluation

3.         Custody Consent Form (Limited Confidentiality Waiver)

 

Release of Information Form (All Psychologists)

If you would like your doctor to release information from your file to a specified individual or agency, please download this form, fill it out, sign it and FAX back to the office at 404-352-4334.

1.         Release of Information Form

 

 

HIPAA   Forms

You are welcome to copy any of these forms for your own information about the ways in which PPA abides by HIPAA statutes to protect your confidentiality.  No information from your file is ever released unless you have signed a Release of Information form, a court has ordered release of information, your insurance company has requested information, or other legal statutes apply.  Further information is provided in each psychologist's service agreement form about this issue as well as Form 1 below.  Form 1 gives you an overview of the HIPAA law which protects your personal health information.  Form 2 can be completed if you request an unusual or highly specific method of communication from the office (e.g. never leaving a voicemail message).  Form 3 can be completed if you want a summary document of when and to whom information has been released, in accordance with the protections discussed above. 

1.         Georgia Notice Form (Summary of HIPAA)

2.         Request for Confidential Handling of Health Information

3.         Request for Accounting of Disclosures

 

 

 

 
 
 
Atlanta Therapy Peachtree Psychological Associates is a certified Therapy specializing in Forms, depression, counseling, therapist, rehabilitation and much more in Atlanta, GA. We also do Grief or Bereavement, Stress, Depression, Anxiety & Panic Attacks, Couples Counseling, Child and Family Therapy, Adult Psychotherapy, Social Anxiety Disorder, Anger Management, Addictions, Eating Disorders, Self Esteem - Life Transitions, Domestic Violence, Obsessive-Compulsive Disorder (OCD), Post Traumatic Stress Disorder and all work related in the 30309 area and surrounding areas in Atlanta