Form Downloads

Please fill out the New Patient Forms linked below and email them to: [email protected]   - You may also print the forms and bring the paper copy to your initial evaluation.

New Patient Forms - GA/ Clinic:

  • Intake Form (English): PDF

  • Patient Screener Form (English): PDF

  • Intake Form (Spanish): PDF

  • Patient Screener Form (Spanish): PDF

 

New Patient Forms - SC/ Natural Environment: Coming Soon

 

Physician Referal Forms

Southland Referral Form - GAPDF

Southland Referral Form - SCPDF