New Patient Forms

If you are new to therapy or counseling or new to Alpharetta Family Therapy please be sure to fill out the following forms, and bring them to your first session, or you can fill out our online questionnaire.

This will help ease you into therapy and allow as much time as possible to focus on you. The form should take approximately 15 minutes to complete and form will automatically save. The automatic save feature will only save for 1-2 days and then the information may be lost.

Fill out the online questionnaire:

New Adult Patients – online questionnaire

New Adolescent Patients – online questionnaire

OR the following forms and bring them with you:

• Adult Intake Assessment
• Authorization to Disclose Information Form
• Child:Adolescent Intake Assessment
• Statement of Understanding

Please go to RATES and INSURANCE Page to find out how to verify coverage prior to the initial appointment.

Before your first visit please take the time to review this important document regarding privacy and confidentiality.

•  HIPAA Form

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

• Authorization to Disclose Information Form

Note: To download Adobe Acrobat Reader for free, click here.

Alpharetta Family Therapy Specialties