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For all new clients, prior to your initial appointment, please complete and print the following online forms. If you are coming for couples or family counseling, each person should complete his or her own set of forms.

 

There are five Required Forms (1-5)* total:
1)  Adult Client Information Form*
or

Child/Adolescent Client Information Form*

2)  Professional Disclosure Form*

3)  Data Sheet Form*

4) HIPAA Privacy Notice*

5) Cancellation Policy*

The credit/debit card form is, of course, completely optional; please complete it if you would like us to keep your information on file to charge services for your convenience.
Credit/Debit Card Form (Optional)

Schedule An Appointment

Counseling Request
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Contact Me

Alpharetta Counseling & Therapy

Beth Z. Jackson (LCSW)

1065 Powers Pl, Alpharetta, GA 30009

P:  (678) 699-0021 | (706) 425-8900