But now, by dying to what once bound us,
we have been released from the law
so that we serve in the new way of the Spirit,
and not in the old way of the written code.
Romans 7:6
Client Form
Please complete the form below if you have scheduled
your first counseling appointment with Ann MacLeod.
This simply saves you time
when you arrive for your appointment.
If the form is not completed online you will be asked
for the information below when you
arrive for your appointment.
The online form is sent directly to Ann MacLeod.
Contact Info.
1093 Redwood Drive
Suite B
Norcross, Ga.  30093

(678) 908-9328
(Client Form)
Date of First
Appointment:
Name
Time:
Street Address
City
State
Zip
Home#
 Work#
Email
Age
 Marital Status
Referral Source
Annual
Income for
your
household
If you have children,
how many?
Ages
Other Comments:
All fees are dues at
the time of service.

Clients need to check
with their insurance
provider to determine
if reimbursement is
available.

Clients are
responsible for
submitting and
processing all the
necessary insurance
documentation.

Please call Ann
MacLeod directly for
fee rates at
(678) 908 9328.