Client Forms

If you’re a new client, please complete the following forms and bring them to your first therapy session.

Client History and Information
AmenBrain System Checklist
Client Consent for Treatment
Acknowledgement of Receipt of Notice of Privacy Practices
HIPAA Form
Distance Counseling Informed Consent Form

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Authorization to Disclose Information Form



455 East Paces Ferry NE, Suite 312 Suite 503 ,
Atlanta, GA 30305

carolyn@tuckerandassociates.me
(770) 789-0847

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