Positive Energy Works

office (404) 816-6262
fax (404) 816-6264
direct (404) 731-6442

Forms

Initial forms must be completed prior to your first appointment. For your convenience, these forms can be accessed from the link below.

Proof of Identity:  You will need to present picture identification to substantiate name and person (e.g. valid driver’s license) when you attend your first appointment.  If treatment has been mandated by another agency, you may need to provide information/documentation. 

  1. Client Information

  2. Health Insurance Portability and Accountability Act (HIPAA)

  3. Consent and Authorization to Treatment

  4. Credit Card Guaranty of Payment

  5. Authorization For Release of Protected Health Information (optional)