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.

Federal Law

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

 

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5755 North Point Parkway,
Suite 79

Alpharetta, GA 30022

info@balanceandpotential.com
(678) 644-0039

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