Intake Forms

Required Client Intake Form

Required HIPPA Notice

Required General Information Form

Please download the PDF documents above, print them, answer the questions, and bring the completed forms with you to your first counseling session.

To make your visit at the Samaritan Counseling Center go as smoothly as possible, please check your insurance coverage prior to arrival. Since insurance plans vary so much today, please call your insurance company to confirm your benefits. On the back of your health insurance card, there is a toll-free number provided for securing information about your mental health coverage. Be sure to ask if your insurance covers counseling. If so, ask the following questions:

• Is my therapist listed as a provider on my insurance panel?


• How many sessions are available during a calendar year?


• What is the amount of the co-pay?


• If there is a deductible and how much has been applied toward this calendar year?


• What percentage of the therapist's fee is covered for each session?


• If my therapist is not in-network, what are my out-of-network benefits?

Samaritan Counseling Center of Atlanta

First Presbyterian Church of Atlanta
1328 Peachtree St. NE, Suite B317
Atlanta, GA 30309-3902
404-228-7777