Julius Jessup Peterson    MDiv, MSW, LCSW Care and Counseling Center of Georgia offers a safe and welcoming place to receive help with life's difficulties. We have 17 counseling sites throughout greater Atlanta.

Julius Jessup Peterson
   MDiv, MSW, LCSW

Care and Counseling Center of Georgia offers a safe and welcoming place to receive help with life's difficulties. We have 17 counseling sites throughout greater Atlanta.

Client Intake Information Form
If you are coming to us for care for the first time, please use this form to tell us more about yourself. 
Available in PDF format for completion.

Counseling Consent Form
Please fill out this form to begin your relationship with our office.
Available in PDF format for completion.

Authorization For Release of Information
If you are transferring care from our office, use this form to have a copy of your records sent to your next place of treatment. This form can also be used to transfer documents to us. Available in PDF format for completion.

Insurance Verification Form
Prior to your first session, to avoid any gaps in your coverage,  we request that you contact your insurer about your mental health benefits. In order to use your insurance and qualify for our discounted insurance rates, you will need to complete this form prior to your first visit.  Available in PDF format for completion.

Notice of Privacy Policy
I adhere to the Georgia State Code of Ethics as well as the Code of Ethics for social workers and HIPAA regulations. The Care and Counseling Center of Georgia expects its staff to follow the laws of the State of Georgia in reporting to the designated authorities intentions on the part of clients to commit suicide, homicide, or incidents of child abuse. (Georgia Code: 19-7-5) 
Available in PDF format for completion.

Mood Chart
In our time together, we will request that you track your mood, so that we can examine patterns and formulate a response that will move your forward with your goals. Available in PDF format for completion.

Collateral/Informal Support Form
Some of our therapeutic work may require input from family, friends, and/or informal supports. This form allows them to provide feedback in response to your symptoms and your progress if deemed necessary. Available in PDF format for completion.

These forms are in Adobe Reader format. If you do not have Adobe Reader installed, you can download it for free from here.