If you are in need of an evaluation for anger management or for family violence, please complete the following forms and once you have completed all the forms here, please call us at (770) 594-5317 to schedule your evaluation.

HIPPA Notice of Privacy Practices: This form explains your rights & responsibilities as a client, as well as explains the limits of confidentiality. You must complete this form stating that you have read and understood its contents. We are a counseling center and normally you would enjoy all reasonable expectations of privacy when attending counseling; however, if you are mandated to the State of Georgia’s Family Violence Intervention Program, there is no expectation of privacy. We are legally mandated to report your attendance, progress, termination, etc. and we are acting as educators for this program, not as your counselor.

Consent for the Release of Information: Please complete this form and provide us with your probation officer’s information. If you are not on probation, please provide us with the contact information of whomever referred you: i.e. attorney, pre-trial officer, employer, employee assistance program, military, etc. If you do not provide us with a signed consent form, we cannot send your referral source an evaluation or even communicate with them that you came to us. If you would like your evaluation sent to multiple sources, please complete this form multiple times, once for each source.