Patient Services & Forms


We are honored that you have chosen our office and are looking forward to seeing you. When you’re a patient at Family 360/Hosanna Ministries Counseling Center, you’ll be treated with the compassion and respect you deserve.

We believe in providing comprehensive care that addresses both your short-and long-term mental needs. If you are a new patient, before your first appointment, there are a few forms you will need to fill out necessary for your first appointment.


Prior to your first visit, please print and fill out the new patient forms below. Please bring these with you to your first visit along with your insurance information and photo ID.

Please arrive 10 MINUTES before your appointment time to allow sufficient time to complete the intake process prior to the start of your initial visit.

(1) Patient Intake Package

You can print out these forms, or fill them out online and email/fax them back to us.


Also, please bring with your insurance card so we can keep a copy with your patient records.

If you are a returning patient, please inform us of any changes in your personal or insurance information. The staff will ask you for this information at the time of your visit. The lack of correct information may cause payment delays or insurance denials that may ultimately leave you responsible for payment.

Co-payments and balances you may owe are due on the day you receive services. If you have questions regarding your co-payment or deductibles, please contact your insurance company.


Call us to schedule your appointment at (770) 679-0586 to get you or your family scheduled. You can also use our online form to request an appointment also.


Please note that we require at least 24-hour notice for appointment cancellations anything less than 24 hours will incur a late cancellation fee of $50. 

Missed appointments are also subjected to a $50 fee.

Cancellation over the weekend:

Please call and leave a message. Your message will be date stamped and there will be no charge if it is greater than 24 hours.

So if you’re still curious about anything or if you’re ready to make your appointment, just give us a call at 770-679-0586 or use our online form to schedule an appointment. We look forward to seeing you!