Informed Consent & Notice of Privacy Practices

Welcome to Playtime Therapy of Georgia!

Please review our privacy practices and clinical policies on this form. The form details our work together and provides consent for treatment. This form must be completed prior to your first session.

Please do not hesitate to reach out to me if you have any questions whatsoever. I am excited to work with you!

What type of therapy services are you receiving? Please select one. *

Play Therapy & Counseling with Children (Including Teens)

Coparenting Counseling

Reunification Therapy

Farm-Based Therapy

Perinatal Therapy