Forms

We seek to make our services affordable while maintaining the highest professional standards. We also understand our clients’ desire for confidentiality and freedom to choose how much and what kind of treatment services they wish to receive. For these and other reasons, we are not currently contracted with any major insurance networks, with the following exceptions:

Jeff Georgi takes Duke’s student insurance.
Becky Georgi takes Duke’s student insurance.

Payments can be made by cash, check, or credit card.  We will be happy to file insurance for benefits which will be returned directly to you.

You may schedule your appointment with Bambi Barnette, Office Assistant, by phone: 919-698-7737 or email: jill@georgicounseling.com

Payment arrangements can be made by contacting Ashley Ferrell, Practice Manager at 984-209-3804 or email: ashley@georgicounseling.com

Please complete the registration form and sign the signature pages for Informed Consent and Notice of Privacy Practices. Fax them to Ashley Ferrell, Practice Manager, 919-375-2131.

You can download and print them from the links below.

Forms:

1. Registration Form
2. Informed Consent for Treatment 2015
3. Notice of Privacy Practices – 2015

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