Please select and complete the forms below that apply to you. For greater ease, our forms can be completed online through our secure site by selecting the first link. Should you prefer, PDF forms can also be downloaded by using the second link, printed and faxed to us at 912-489-1630.
Online forms should be completed on a desktop computer, laptop, or workstation.
- New Patient Registration Online Form | PDF Form
- Registration Update Online Form | PDF Form
- Psychotherapy Appointment Policy Online Form | PDF Form
- Authorization to Release Records Online Form | PDF Form
- HIPAA Notice of Privacy Practices Online Form | PDF Form
- Patient Privacy Form Online Form | PDF Form
- Consent for Treatment Online Form | PDF Form
- Child and Adolescent Booklet
Insurance & Billing
- Credit Card Authorization Form Online Form | PDF Form
- Insurance Form Online Form | PDF Form
- Medicare Benefit Waiver Online Form | PDF Form
- Medicaid Benefit Waiver Online Form | PDF Form
- Tricare Benefit Waiver Online Form | PDF Form
- Child ADHD Rating Online Form | PDF Form
- Adult ADHD Rating Online Form | PDF Form
- Vanderbilt ADHD Parent Rating Scale PDF Form
- Vanderbilt ADHD Teacher Rating Scale PDF Form
- PHQ-9 Online Form | PDF Form
- GAD-7 Anxiety Scale Online Form | PDF Form
- TASS Online Form | PDF Form
- Content of Schemas Online Form | PDF Form
For the PDF version:
If you complete the PDF in your browser, save the PDF to your computer after you’re finished by clicking Print instead of Download and select “Save to PDF” under the Print Options. Please note, selecting Download will save a blank version of the PDF to your computer, and your entries will not be transmitted.
If you complete the PDF in Reader or Acrobat, download it to your computer and fill it out in Adobe Reader (available for free) or Adobe Acrobat. You can save the file normally and either print or email the file as you’d prefer.
Visit & Policies
The purpose of the initial evaluation is to obtain a detailed history for an accurate assessment. At times, your provider may need to obtain additional information from other health care professionals and, in the case of minors from teachers, before generating a diagnosis and/or recommendations.
Upon the conclusion of the evaluation, your provider will discuss his/her assessment and impressions with you, and make recommendations regarding the need for follow-up, medications and/or psychotherapy. Often psychotherapy is a helpful adjunct to medication or an effective stand-alone treatment.
Based on the evaluation, your provider will have our staff schedule follow-up visits for you. These visits may be more frequent during the initial phase of treatment. If medication is prescribed, your doctor will monitor your response to the medication, and monitor for side effects during follow-up visits.
For your benefit, a covering provider will be available for important issues after office hours via phone. The on-call provider can be reached by calling 912-531-4886. This number is also listed on our office voicemail message. For emergencies of an immediate nature, please call 911 or go directly to the emergency room at the nearest hospital.
Our office does not routinely change/modify prescriptions over the phone. Please schedule an appointment if a medication change is needed.
To ensure that you have your medications in a timely fashion, please call your pharmacy at least 2 business days before it is needed. For these standard refills, please do not call the office. Please note, if you need a medication refill, but have missed and are overdue for an appointment, you will most likely need to be seen before a refill request can be approved.
- Controlled Substances/Stimulants: Can now be requested by your pharmacy and e-prescribed. Please call your pharmacy for refills at least 2 business days before needed.
Please plan ahead to avoid running out of medications over the weekend or after hours. When necessary, emergency weekend prescriptions are given for no more than 7 days of medication. For controlled substance refill after hours, no more than a 5 day supply will be refilled by the on-call physician to cover you until you are able to contact your treating physician.
We are glad to help you with your mail-order prescription services. Please note, as with other medication refills, we will only be able to provide these 90-day prescriptions if you are current with your appointments.
Always discuss any changes or side effects from medications with your doctor. If problems occur with a medication, please contact our office.