Download Forms
Complete your forms before your first visit to help us verify your benefits and schedule your first appointment faster.
Intake & Referral Form
New Intake & Referral Report — for new clients and referrals.
Make an AppointmentAuthorization for Release of Confidential Medical Records
Lets your previous doctor, therapist or agency send your records to Willow Oak. Have them fax the records to 770-683-6949.
Medical Release FormThank you for your interest in Willow Oak Community Behavioral Health Center. Please complete all forms indicated on this page and submit in your preferred method as indicated below. Include with your submission a copy of your state issue Identification & insurance card. If applicable include your military referral letter and/or EAP authorization letter. These items will help expedite verification of benefits eligibility for first appointment scheduling.
Include with your forms
- Copy of your state-issued ID
- Copy of your insurance card
- Military referral letter (if applicable)
- EAP authorization letter (if applicable)
Send them in the way that works for you.
Choose any one of these options.
Fax
770-683-6949
55 Jefferson Parkway
Ste. 55B
Newnan, GA 30263
Already a patient? You can complete required forms online through your patient portal.
Patient Portals