Call Us:  +1.7065488697

Fax, mail, or bring the completed forms to our office.  

If you choose to accept the privacy risks involved, you may email the completed forms to us at By doing so you agree to accept that emailing personal health information puts the privacy of that information at risk.   

Once we receive the completed forms, we will verify insurance benefits and the provider will review the information.   

Our goal is to provide a response to you within 3 business days.  Contact us if you have not heard from us in this time.

New Patient Forms

​​Athens Psychological Services

Print a copy of the appropriate new patient forms below.  

Child or Adolescent  (All Providers)

Special note regarding children and adolescents:

If applicable, we must have copies of custody, guardianship, or adoption papers before we can schedule any appointments.

Adult  (Millie Kelleher, L.C.S.W. or Jaclyn Peters, Ph.D.)