Telehealth Services: Video Therapy Available Call 678-893-5300 to Schedule an Appointment.

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Office Policies

Our waiting rooms are currently closed. Social distancing is highly enforced and we ask that you do not enter unless contacted by your clinician. We ask that you bring your own mask as we only have limited availability by request.

Our client engagement team is available at 678-893-5300 to schedule your appointments or answer any questions you have during regular business hours:

Monday – Thursday 8:30am-8:30pm
Friday 8:30am-6:00pm

If you are having a mental health emergency during non-business hours, please contact 911 or proceed to your nearest emergency room for immediate care.

The Summit Counseling Center is considered an “out of network provider”. Our therapists will provide you with a receipt that will contain the date of service, diagnosis code, and payment made – for you to use when filing for reimbursement. Because each policy differs regarding co-pays, and deductibles, we advise you to contact your individual insurance company to confirm coverage.

Appointment Cancellation Policy
A professional time commitment is reserved and held exclusively for you. If you need to cancel or reschedule, please notify our front office staff at 678-893-5300 at least 24-hours in advance. If the change is made with less than 24 hours’ advance notice or if you do not keep your scheduled appointment, you will be responsible for the full fee.

Payment is due at the time of service. Forms of payment accepted are: Cash, Check, Major Credit Cards, and Debit Cards

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New Client Documents

On this page you will find the forms that need to be completed on your first visit and documents that provide you with important information about our services.  If you prefer to complete these forms ahead of time, please feel free to download them, fill them out at home, and bring them to your first appointment.  Otherwise, if you’d rather fill out the forms at our office, please plan to arrive at least 20 minutes ahead of your first appointment time.

First Appointment Forms

Client Information and Client Consent for Treatment
This form gives us your contact information and also serves as your consent for treatment. Please fill it out and bring it with you to your first visit.

Client History
This form provides your therapist with information about the reason for your visit. Please fill it out and bring it with you to your first visit.

Policy Agreement
Must be signed for all clients

Agreement and Information for Parents of Minor Children
Required for all minors

DeKalb County Parent Agreement
Required for all minors seen at a Dekalb County School

Fulton County Schools – Mental Health Provider – Parent Authorization
Required for all students seen at a Fulton County School

First Appointment Documents

Summit Client Rights and Responsibilities
This document spells out your rights and responsibilities as a client of The Summit. Please download it and read it in its entirety.

Standard Fee Information
This is a brief summary of our standard fees for services.  Not all of our services are listed.  To receive fee information for any of our specialized services, please contact our front office staff at (678) 893-5300 and we will gladly provide this information for you.

Summit HIPAA Privacy Policy
This document is federally mandated by HIPAA (the Health Insurance Portability and Accountability Act) to confirm that the privacy and confidentiality of your health care information is protected and maintained. Please download it and read it in its entirety.

Optional Documents

Directions to The Summit
For your convenience, we are providing accurate directions and a Google map of our exact location. Should you need any assistance in finding our building, please call our office at (678) 893-5300.

Client Assistance Fund (CAF) Application Form
The Summit’s Client Assistance Fund (CAF) is available to help underwrite and supplement the fees of those clients who may not be able to afford our full standard fee.  If you think you would need to apply for our CAF support, please download and fill out this form.  Remember also to bring the supporting documentation that verifies your income to apply for these funds.  Click here to learn more about the Client Assistance Fund.

Consent for Use of VideoTherapy

Waiver and Release of Liability – Coronavirus

Guarantor and Online Payment Form

It is our privilege and pleasure to serve you at The Summit.  If you need further assistance about any of these forms, please contact our office staff at (678) 893-5300.  We look forward to seeing you.