The use of the Internet or this form for communication with John R. Paddock, Ph.D., ABPP, LLC does not establish a
psychologist-patient relationship. Confidential or time-sensitive information should not be sent through this form.
Brookwood Exchange Building
1708 Peachtree ST NW Suite 400
Atlanta, GA 30309-7022
Office Telephone: 404-874-3498
Office Fax: 404-874-8305
John R. Paddock, Ph.D: firstname.lastname@example.org
While the HIPAA Security Rule does not expressly prohibit the use of email for sending electronic PHI, know that your PHI may or may not be protected.
Please download, print, and complete each of these forms prior to your first appointment.
1. HIPAA Practice Policy
2. New Patient Form 2016
3. Psychotherapy Relationship Informational Questionnaire
4. Email Consent Form
5. HIPAA Informed Consent
6. Informed Consent for Telepsychology
*Please do not submit this information via email. Instead, bring it with you to your appointment.