Client Forms

If you are new, please feel free to fill out these intake forms before our first session. These forms can also be filled out during the first session.
tionnaire

Parent Questionnaire

Adult Questionnaire

HIPAA Notice of Privacy Practices

Consent & Authorization to Release Information

Instructions for filling out Consent & Authorization to Release Information Form

DBT Diary Card

Contact Us Today



5755 North Point Parkway,
Suite 79

Alpharetta, GA 30022

info@balanceandpotential.com
(678) 644-0039

Have a Question?
Send a Message!