770-602-1979
drdavidclark@bellsouth.net

Evaluation and Admission Paperwork

Domestic Violence/Anger Management Forms

Satellite sites are available in Conyers, Covington, Decatur, Snellville, and Tucker, Georgia

1: Domestic/Family Violence Screening: Use this form if the courts/probation have said you need to attend a Family Violence Intervention Program. Victim is usually a spouse, girlfriend, boyfriend, child or parent.

2. Anger Management/Relationship Screening: Use this form if the courts/probation marked "anger management" and the victim is a spouse, girlfriend, boyfriend, child or parent.

3. Anger Management Evaluation: Use this form if the victim is a stranger, neighbor, police officer, co-worker.

Alcohol and Drug (DUI) Evaluation Paperwork

Please fill out the following forms to complete your DUI evaluation:

Evaluation:
https://form.jotform.com/81564354666162

Alcohol and Drug (non-DUI) Evaluation Paperwork

Please complete the following forms prior to your alcohol and drug (non-dui) evaluation:

Evaluation:
https://form.jotform.com/81564354666162

DUI Admission Paperwork

DUI Intervention Program - Admission Package - please read and consent online using this form for all DUI clients prior to starting treatment.