3455-A Lawrenceville-Suwanee Road, Suwanee, GA 30024
Phone: (770) 932-2899 Fax: (770) 932-2895
Copyright 2016. North Gwinnett Counseling Associates. All Rights Reserved.
New Patient Forms
Below is a list of forms necessary for your first appointment. Please take a few moments to review and complete them.
Forms necessary for all clients:
Notice of Privacy Practices (HIPPA)
Insurance and Billing Policy Form
Consent to Treatment
Adult Information Form or Child Information Form
(Please be advised that we must have a copy of any divorce decree or custody agreement applicable to the child)
Form only necessary if applicable to you:
Release of Information (This form grants permission for your counselor to consult with other professionals such as your physician or attorney regarding your treatment)