Client Forms
Our Primary Focus

The following forms are to be printed and signed before your first appointment.

  1. New Patient Forms ( 395k)
  2. Medical Section ( 154k)
  3. New Patient Intake Worksheet ( 16k)
All Information is Kept Strictly Confidential

Clinical information is kept either physically secure or on a secure, encrypted web server which is compliant with U.S. federal health information technology standards (HIPAA)
Absolute confidentiality is assured. Information is only shared under the following circumstances:

  1. Under the client's direction & written consent
  2. For the coordination of emergency health care where obtaining proper consent is either impossible or would cause such a delay that harm would ensue
  3. To guard against imminent danger to the safety of an adult or child
  4. Under the direct order of a judge or court

For more information, download our Notice of Privacy Practices, above.

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- Client Forms
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- Location Maps

  Villa Rica Office
  690 Dallas Hwy, Suite 201
  Villa Rica, GA 30180
  Tel: 678.840.8446
  Fax: 678.840.8482
Business Hours
Monday: 8-5 (closed 12-1)
Wednesday: 8-5 (closed 12-1)
Friday: 8-1
Lithia Springs Office  
560 Thornton Road, Suite 120  
Lithia Springs, GA 30122  
Tel: 678.840.8446  
Fax: 678.945.4221  

Business Hours
Tuesday: 8-5 (closed 12-1)
Thursday: 8-5 (closed 12-1)
Maintained by NetLine Access, Inc.
©2019 The Neuropsychiatric Clinic of Atlantis. All Rights Reserved.