ER 2025 Registration

Select Your Group Preference

New participants with an outside therapist are required to attend a 60 minute pre-registration intake assessment with one of our providers prior to attending a group. If you have attended a previous module at our practice, you do not have to complete the intake assessment. Current modules are 8 weeks in length.
Group Options:*

Adult Group (VIRTUAL) - Mondays 10-12pmAdult Group (VIRTUAL) - Tuesdays 6-8pm (this class is currently full)DBT-C Multi-Family Group (IN PERSON) - Tuesdays 5:30-7pm (this class is currently full)Adolescent Multi-Family Group (IN PERSON) - Wednesdays 6-8pm (this class is currently full)Adult Group (IN PERSON) - Thursdays 6-8pm (this class is currently full)
Group Calc
Add-on Calc
Does the participant have a therapist with Peachtree DBT?*
Who is your current primary Peachtree DBT therapist?*
Remember that participants are required to be seeing an individual therapist weekly.
Who is Your Current Primary Therapist? *
Remember that participants are required to be seeing an individual therapist weekly.
Is the participant currently enrolled in a Skills Group module, or has the participant recently attended a group module within the previous six months at Peachtree DBT?*
A pre-registration intake assessment is required. Please continue in order to submit a request.

DBT Skills Group: Client Release of Information
Participant's Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Outside Therapist's Email Address*
The above email address will be used to automatically send your provider the outside provider form for them to complete.
Outside Therapist's Phone Number*
Please enter a valid phone number.
I authorize full communication and the release of any pertinent medical information between my therapist and Peachtree DBT/Peachtree Comprehensive Health. I understand I will not be eligible to participate in the Peachtree DBT Skills Training Program unless I regularly attend individual therapy sessions on an on-going basis. There will be a case management fee for all clients with a therapist outside of Peachtree Comprehensive Health.
Patient/Guardian's E-Signature *

Clear
Guardian's E-Signature

Clear
After submitting this form to our office, the skills training instructor will contact your primary therapist to establish an open line of communication in order to discuss the client's diagnosis and any important clinical information.

Group Selected:
+ Case Management Fee (Required for participants with outside providers):*

Case Management Fee: $80.00
NEXT STEPS

Following submission of this form, our team will contact your shortly requesting any further forms that need to be completed. you will receive an email with instructions on how to finish your registration.

Please note the following:
- If you do not have a therapist with PCH or have not attended a DBT group through PCH in the last 6 months, an orientation intake session is required before joining the class.
- A Credit Card on File is required prior to scheduling the orientation appointment (this form is included in your registration forms).
- All orientation paperwork must be completed, including the Treating Therapist Agreement form and a consultation call with your therapist, before we can schedule the orientation session.
If you have any questions, please reach out to Rhonda, our clinical coordinator, directly at 404-351-2008 ext. 236

My Products*

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Select Your Group Preference