PATIENT FORMS


Here's how you can save time at your first appointment:

  1. Click here to read the HIPAA and Professional Service Agreement documents.
  2. Click here for Release of Information Form. (This is an optional form that does not have to be filled out for your first session.)
  3. After you have read these documents, please Click here to print out, sign and bring with you the following forms to your visit. Patient Information Form, Hipaa agreement and Medical Release form.
  4. Click here for our Credit Card Authorization Form. This form allows Powers Ferry Psychological Associates, L.L.C. to charge any credit card you provide for any services rendered. Credit cards are ran on the 15th and the last business day of each calendar month. (This is an optional form that does not have to be filled out for your sessions.)
  5. Click here for our One Time Credit Card Authorization Form. This form allows Powers Ferry Psychological Associates, L.L.C. to charge any credit card you provide for any services rendered for only one non-reoccurring transaction. (This form is typically used for patients who would like to make a single payment toward any incurred balance.)

Thank you and we look forward to working with you soon


© 2004-06 Powers Ferry Psychological Associates, LLC

1827 Powers Ferry Rd. Bldg 22, Ste. 200
Atlanta, Ga. 30339
P: 770-953-4744
Fax: 770-953-4640

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