Make an Appointment

Let’s Get Started!

After you complete this form, we will send you an email within 24 hours (or on the next business day) telling you how to sign up for our secure client portal so you can tell us more about yourself. Or we will call you if you prefer. Our phone line is not continuously monitored, so you will need to leave a message when you return our call.

IF YOU WOULD LIKE COUPLE COUNSELING OR FAMILY COUNSELING, each person must submit a separate form with a unique email address.

This form is not designed for emergencies. If you are experiencing an emergency, please call 911 or 988 or go to the nearest hospital.

Also, due to differences in state laws that govern the practice of counseling, we are unable to counsel people who are not physically located in Georgia—even via telehealth.

Name

First Name

Last Name

Phone

(###)

###

####

Are you at least 18 years old?

Yes--I am at least 18 years old.

No--I am under 18 years old.

How can we contact you?

Please send me an email that will allow me to access your secure client portal.

Please call me for an appointment at the phone number provided.

Which answer best describes the type of counseling you are interested in?

Name of Person Needing Counseling (If Not Yourself)

First Name

Last Name

Which best describes you?

Would you like to request a specific counselor (if available)?

Which location would you prefer?

“No Surprises Act” Notice

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.