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Welcome

Welcome

Atlanta Counseling Collective and Peachtree DBT work collaboratively to provide specialized, evidence-based care. You do not need to know which program, treatment approach, or clinician is the best fit. Our clinical director personally reviews each inquiry to help guide you toward the most appropriate services. Please provide accurate and detailed information so we can best support your care and connect you with the right specialists. Your health and well-being are our top priorities.This confidential form is sent to our clinical director for review. If you are having a mental health emergency please dial 911 or proceed to your nearest emergency room. If you need to reschedule or cancel an existing appointment please place a request through your Patient Portal.
20Questions
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  • 2
    Please Select
    • Please Select
    • Yes
    • No
    • Follow up needed
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    -
    Pick a Date
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  • 8
    Please provide the phone number of the parent or guardian who should receive updates and scheduling information.
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  • 9
    Please provide the email address of the parent or guardian who should receive updates and scheduling information.
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    (Select all that apply)
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    for example: after school, evenings, early morning, lunchtime, daytime, certain days of the week etc.
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    Substance use, suicidal ideation, self harm, etc.
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  • 19
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    Please list referring provider if applicable
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