CALL 229-339-3721

FORMS

Please complete the forms and submit on-line by clicking Complete On-line below. Or download and print out a PDF version of the form to complete and bring in the office by clicking Download & Print

DEMOGRAPHIC INFORMATION FORM: Complete On-line | Download & Print (PDF)

INSURANCE INFORMATION FORM: Complete On-line | Download & Print (PDF)

HEALTH INFORMATION FORM: Complete On-line | Download & Print (PDF)

CONSENT FOR TREATMENT FORM: Complete On-line | Download & Print (PDF)

HIPPA FORM: Complete On-line | Download & Print (PDF)

RELEASE OF INFORMATION FORM: Complete On-line | Download & Print (PDF)

PROVIDER REFERRAL FORM: Complete On-line | Download & Print (PDF)

COUPLES INTAKE FORM: : Complete On-line | Download & Print (PDF)

WITNESS CONSENT FORM: : Complete On-lineDownload & Print (PDF)

tiftareapacs.com

Tiftarea Psychiatric and Counseling Services, LLC. | Office Address: 223 East 2nd Street Suite B Tifton, Georgia 31794
Phone: 229-339-3721 | Fax: 229-472-9151 | Mailing Address: Post Office Box 1613 Tifton, Georgia 31793
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