Forms & Directions

2018  CLIENT INTAKE Packet For New Counseling Clients Requesting an Appointment: 

  1. Please print and complete the appropriate form(s) below prior to your appointment. This ensures we make the most of your initial visit.

  2. Bring your completed Counseling Packet & Insurance Verification Form along with patient(s) insurance card  and a picture ID of patient/parent/guardian.

  3. After speaking with our staff to confirm an appointment time, please secure your appointment by clicking on the  “Pay Now” PayPal tab on the Payment page. There is typically a $50 reservation/admin fee when scheduling a new counseling patient visit. This includes a set administrative fee of $30.00, the remaining will go towards your first visit payment/copay.

This will help speed up your check in process. We appreciate your cooperation and understanding!

We do accept most major credit/debit cards (with a 2.00 processing fee) , personal checks made out to:
Dr. Kathy Howell, and cash payment for established patient visits.

 

New Client Counseling Forms:

2018 CLIENT INTAKE Packet

HIPAA (Client Copy) 2018

HIPAA Signature Form

Insurance Verification Form 2018

Five Brain Systems Checklist

Symptom_Survey

 

Form Specific to Counselor:

Disclosure- Kathy Howell

Couples & Family-Confidentiality-Kathy-Howell

Minor Confidentiality- Howell

 

General Nutritional Forms:

New Patient Information Form

Symptom Survey Form

Permission and Authorization Form

Five Brain Systems Checklist

 

                   Directions                           

   Please note, we are in a residential neighborhood. Your cellular carrier may not provide service in this area, just ask for our wireless password if needed.         

From Ga Hwy 400 –
*Turn onto 136 West towards Dawsonville; go 3/10 of a mile.
*Take the first paved street on your LEFT (River Bend Road/ aka “Dawson Cove”); go 8/10 of a mile.
*Our driveway is located on the RIGHT (786 River Bend Rd.) at the bottom of a large hill.
*Follow the gravel driveway; bear LEFT onto the circular concrete driveway.
            Four gravel parking places are to your left and more are available in the upper lot.  There are handicapped parking spaces available in front of the garage area.

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View from the Pond

 

 

 

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