ADULT Intake Form 2017
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Booking Fee Notice

Please note that at the end of this form you will be required to make a payment with your credit card and secure your first session with Dr. Malcolm Anderson. Without this payment, the form will not be submitted and the booking will not be made. If you are unable to make payment at this stage, please do not continue with the intake form and contact our office at (770) 582-0532 or

For the best results and for your welfare, it is very important that you take a few minutes to read and understand what it means to be in psychotherapy. This form provides a brief description of what you might expect if you haven’t been in therapy before. If you understand the information on this form and choose to begin treatment sign and date this form and return it to your therapist. If you have any questions or concerns about the information on this form, you are urged to discuss them with your therapist.

Psychotherapy is a special kind of health care service. The goals of psychotherapy are to help you find solutions to problems that may be limiting your lifestyle satisfaction, and to help you cope better with the feelings and challenges that you may be encountering in your daily life.

The most common method of psychotherapy involves you talking about your thoughts and feelings, your problems or concerns, and your experiences of yourself and your situation. Other common methods involve using your imagination, keeping personal records of your experience, and trying new and/or different ways of thinking, acting, or feeling. These methods may be used within treatment sessions or you may be asked to do them at home.

To better understand your experiences, thoughts and feelings, many psychologists use a variety of tests or measures to estimate your current abilities and ways of experiencing things. These measures are important in choosing the treatment method that is best suited to you, and they are also helpful in estimating your progress.

The length of treatment often depends on your individual needs and the rate of your progress toward agreed upon goals. Many psychologists use periodic reviews as a means of evaluating your needs, progress and satisfaction.

Most people benefit from psychotherapy. The most common benefits include improvements in self-awareness, self-esteem, self-confidence, hope, feeling understood, relationships with other people, emotional expressiveness, and taking an active and responsible role in one’s life. There are also some risks to being in psychotherapy. The most common risks are temporary periods of emotional distress related to changes in your life situation and your relationship with yourself and others (including your therapist). Psychological harm caused by psychotherapy is rare, but you should be aware that it could happen. The most common causes of such harm are poor communication or unethical conduct. If you feel that you are not making reasonable progress or that you are being harmed by your involvement in psychotherapy, you should discuss this with your therapist. If you feel that your therapist has attempted to violate you in any way – financially, physically, sexually, or otherwise – you should inform the state licensing board.

You always have the right to choose whether or not to continue in psychotherapy. If you feel that you might work better with a different therapist, your current therapist should be able to offer information on possible referrals. Local mental health agencies are listed in the telephone book and they may also offer helpful information. The more common alternatives to psychotherapy are: self-help or support groups, therapeutic reading, and different forms of religious counseling.

Communication is essential to successful psychotherapy. You are urged to ask questions, express concerns, and share information about your personal life with your therapist. This information must be kept private (confidential) by your therapist unless you grant permission to release it to a third party. The ONLY EXCEPTIONS to this protection of your privacy are dictated by state laws. For example, your therapist is legally obligated to report incidents of child abuse or threats of violence that may place you or another identified person in danger of personal harm. You are urged to discuss this issue and the limits of confidentiality with your therapist.

Your signature below indicates that you have read and understood the above description of psychotherapy and consent to be in psychotherapy with the understanding that you retain the right to review and revise the decision at a later time.