(706) 490-9204 | tina.wallis@yahoo.com

Tina Wallis | https://www.walliscounseling.org/

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Client Forms

If you are new to therapy or counseling, please be sure to review and complete the following forms, and bring them to your first session. This will help ease you into therapy and allow as much time as possible to focus on you.

Client Registration Form

Client Intake Information

Confidentiality and Informed Consent

HIPAA Notice of Privacy Practices

Acknowledgement of Receipt of Notice of Privacy Practices

Referral Information

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Tina Wallis, LPC, MAC, CPCS



(706) 490-9204
tina.wallis@yahoo.com

131 Prominence Court, Suite 220
Dawsonville, GA 30534

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Contact Information

131 Prominence Court, Suite 220
Dawsonville, GA 30534

P.(706) 490-9204
tina.wallis@yahoo.com

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