For More Information

Please do not use this form if you have an urgent problem or you need to reschedule an existing appointment. Instead, contact our office at (770) 815-6853. After you submit your request, our appointment scheduler will respond within 48 hours. See below for forms to complete. Established patients may log in to the patient portal to request appointments and update forms.

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Patient Registration Forms

Atlanta Specialized Care in Atlanta, Georgia welcomes you to our practice. Once you have made your initial appointment, you may preregister by downloading, printing, and completing the forms below. Doing so prior to your visit will help speed up the new patient registration process.

Downloadable Forms

Admitting Form
Self-Report – Adult
Self-Report – Child and Adolescent
Consent to Release or Receive Information
Patient Health Questionnaire
Atlanta Specialized Care Telemedicine Informed Consent
Coordination of Care Form
Disclosure for Kathryn Butler, FNP-BC
Disclosure for Tatiana Matthews, MS, LPC, CRC
Disclosure for Erin Mills, MSW, LCSW
Disclosure for Natalie Stadnick-Uhl, M.Div, APC, CRC
Disclosure for Neitcha Thomsen, LMSW, LCSW
Disclosure for Theresa Westfall, MS, LPC, NCC
Disclosure for Alicia Porter, MS, LPC, NCC
Disclosure for Melinda Barefoot, MS, APC
Disclosure for Bre Curtin, BS
Disclosure for Megan McKinney, LMSW
Disclosure for Ross Mills, BS

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