Program Referral and Intake Form

Family Intake Form

Please fill out this form to get started with our Services

    (Place a check next to the Service/s you’re interested in receiving)

    Behavioral Health AssessmentIndividual CounselingFamily & Group CounselingParent Skills TrainingSocial & Life Skills TrainingNursing AssessmentCrisis InterventionPsychological TestingSelf-Esteem BuildingPsychiatric EvaluationMedication ManagementDiagnostic AssessmentCommunity Linkage/ SupportDrugs & Substance AbuseCoping/Skills Management



    “If yes, we cannot service them until they’re discharged



    If yes ,

    Contact us to schedule an appointment.

    3883 Rogers Bridge Road, Suite 202A, Duluth GA. 30097, U.S.A
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    Phone Number: +1 (770) 545 8359
    Fax Number: (229)-515-4233