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Phone: 404-333-8829

Fax: 980-495-8849

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Credit Card Authorization Form

Credit card on file on is required to confirm all New Patient appointments. Your credit card will NOT be charged until after your scheduled appointment time.

Cancellation Policy: If an appointment is missed, or canceled within 24 business hours, you will be charged the full session fee.

  • I have read and agree to the cancellation policy above.
  • I understand that Mindspring Health Inc. is out of network on my insurance plan and does not bill insurance directly.
  • I understand I am responsible for payment in full at the time service is rendered, unless other arrangements have been made.