Contact Information

Cindy Baker, MA, LPC
Licensed Professional counselor

110 Evans Mill Drive, Suite 305 (Dallas Family Counseling Center)
Dallas, GA 30157

 Contact: 678.882.2227

Fax: 770.445.7262
Email: cindy@cindybakercounseling.com

Company website: Baker Counseling Resources, LLC

Self pay and sliding scale based on financial need are offered. Please call for rates.

Below is a list of some of the insurance plans I accept.

Aetna
Blue Cross Blue Shield
Coventry
EAP Consultanta
First Health
Humana
Multiplan
MH Net
Peachstate for Kids
PHCS
Tricare

Forms for New Clients

    For your convenience, you may download and complete the following forms in advance or arrive 15 minutes prior to your first appointment to complete the paperwork at the office. Also, please bring a photo I.D. and your current insurance card to  the appointment.

Different computer systems open links to forms differently.  Click on each link below. If your computer opens the form you may choose from your program's menu to save or print the form.  If your computer asks to save the form, save it to a folder on your system where you can find it  then click on it there. Your computer will use your word processor (Word) or PDF program (Adobe) to open the form.

1500 Health Insurance Claim Form

Do not fill out the entire 1500 Health Insurance Claim Form.  Please only "sign, date and sign" the form in blocks "12" and  "13".

New Client Information Sheet
Client's Rights and Responsibility Statement
Permission to Release Information to Primarcy Care Physican
Informed Consent Document
Cancellation Policy
Fee Schedule