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    • Home
    • 日本語
    • Services & Fees
      • Assessment & Evaluation
      • Psychotherapy & Treatment
      • Service Fees
      • Articles & Resources
      • Telemental Health
    • Our Team
      • Clinicians
      • Leadership
      • Dr. Todd George
      • Dr. Andrew Gothard
      • Dr. Yoshitaro Oba
      • Administrative Team
    • Contact Us
      • General Contact
      • DFCS Referral Forms
      • Feedback Form
    • Forms
      • Forms
      • Download & Print Forms
      • Feedback Form
      • Good Faith Est Notice
    • Training
      • Training
      • Post-Doc
      • Practicum
    • What is ABA?
Atlanta 
Psychological 
Services

Signed in as:

filler@godaddy.com

  • Home
  • 日本語
  • Services & Fees
    • Assessment & Evaluation
    • Psychotherapy & Treatment
    • Service Fees
    • Articles & Resources
    • Telemental Health
  • Our Team
    • Clinicians
    • Leadership
    • Dr. Todd George
    • Dr. Andrew Gothard
    • Dr. Yoshitaro Oba
    • Administrative Team
  • Contact Us
    • General Contact
    • DFCS Referral Forms
    • Feedback Form
  • Forms
    • Forms
    • Download & Print Forms
    • Feedback Form
    • Good Faith Est Notice
  • Training
    • Training
    • Post-Doc
    • Practicum
  • What is ABA?

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Patient Forms

For your first appointment

Please complete the following online forms:


  1. Health History Form  - Adult
  2. Health History Form - Child
  3. Client Information & Communications Agreement
  4. Consent to Receive Services/Confidentiality/Payment Agreement
  5. Release of Information
  6. Release for Court Testimony
  7. Telemental Health Consent


Telehealth: Please submit forms within 12 hours of your first appointment. Without these forms, your Telehealth appointment will need to be rescheduled.


In-office appointments: COVID-19 Hold Harmless Disclosure


Give us a call or email if you have questions about which forms are needed.


Haga clic aquí para obtener formularios para pacientes.

Patient Feedback Form

We value your feedback and invite you to complete a brief feedback form about your experience. 

Patient Feedback Form

Release of Information Forms?

When you want your clinician at APS to share your protected health information (PHI), you need to complete a  Release of Information form (sometimes called an "ROI"). The ROI you provide tells your clinician how/to whom they may share your information (your PHI). 


Protected Health Information (PHI) includes:

  • Your Evaluation Report and Findings
  • Your Mental Health Diagnoses
  • Your Treatment Summaries
  • Your Treatment Recommendations


The Release of Information agreement is needed for the APS clinician to share your protected health information (PHI) with others. 


You may want your clinician to communicate with one or more of the following:

  • Healthcare providers (Pediatrician, Psychiatrist, Surgeon, Psychologist, Therapist) 
  • Court officials (Probation Officer, Attorney, Judge) 
  • Agencies (DFCS, DJJ, Social Security, Police)
  • Schools, Teachers, or Guidance Counselors
  • Treatment Center,  Healthcare Practice, Hospital


Click below if you are ready to complete the Release of Information form for your APS clinician. 

Release of Information Form

HIPAA Privacy Notice

Click here to view our HIPAA Privacy Notice

Good Faith Estimate Notice

Click here to view our Good Faith Estimate Notice

Social Media Policy

Click here to view our Social Media Policy

For Downloading and Printing Forms

Click here for Download and Print Forms
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Atlanta Psychological Services

2308 Perimeter Park Drive, Atlanta, Georgia 30341, United States

770-457-5577

Info@AtlantaPsychological.com

Copyright © 2023 Atlanta Psychological Services

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