The Center for Family Psychiatry Patient Forms

Office:
770-486-1011

Patient Forms

Adult New Patient Package

Child N ew Patient Package

C onsent to Release Medical Form

Current P atient Information Form

First-time patients must bring the following items to their initial
visit:

Insurance card
Co-pay or deductible
Driver’s license (if applicable)
Fully completed, New Patient Forms (Adult or Child,
download below)

Important: If you are unable to bring the completed forms
with you, then please arrive at least 45 minutes ahead of your
scheduled appointment time. If you arrive late or without the
proper paperwork, your appointment may need to be shortened
or possibly rescheduled.

The Center for Family Psychiatry

Holistic Approach to Mental Health

The Center for Family Psychiatry
Mission Statement

"To provide the best care with
empathy and compassion to all our
patients and their families"

Cynthia Duncan, APRN - The Center for Family Psychiatry

New Patient Instructions:

Adults: Please fill out and print the forms in the Adult New
Patient Packag and bring them with you at your first visit.

Questions:

Call the office for
additional
information.
770-486-1011

Children: Parent(s), please fill out and print the forms in
the Child New Patient Package and bring them with you at your
first visit.

Other Forms