Please complete the following forms, and bring them to our first session
New Patient Information – This is a general patient information form.
Consent Forms Packet – This packet contains the following:

    General Policies and Procedures
    Informed Consent Form
    Notice of Privacy Practices
    Consent to Use and Disclose Health Information Form
    Fee for Services Agreement
    Credit Card Policy
    Authorization of Release Form**  
    The last five pages are copies for your records.  

    **The Authorization of Release Form only needs to be completed if there is someone you would like for me to
    communicate with regarding our sessions [e.g., doctor, family member, school].  
Parent’s Checklist – This file contains a background questionnaire for parents of children attending
therapy.  
Adult Intake – This file contains a background questionnaire for adults attending therapy.
D. Craig Kerley, Psy.D.
Licensed Psychologist
3949 Holcomb Bridge Road
Suite 202
Norcross, GA  30092
770-449-0082 Telephone
678-623-8234 Fax
info@drkerley.com