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Document Center

  • Evaluations
    • Custody-evaluation-consent-form.pdf
    • Informed-consent-to-participate-in-a-child-custody-evaluation.pdf
  • Intake Forms
    • Adult-Intake-Form-6-18.pdf
    • Adverse-Childhood-Experience-Questionnaire.pdf
    • Billing-Information-and-Agreement.pdf
    • Child-Intake-Form-6-18.pdf
    • Clinician-Patient-Services-Agreement.pdf
    • Consent-to-Use-and-Disclose.pdf
    • DSM-5-Child-Rating-Form-.pdf
    • Telemental Health Informed Consent Mosaic-2018.pdf
  • Privacy Practices
    • Authorization-Form-Obtain Release-Information.pdf
    • HIPPA-2018-Mosaic.pdf
  • Referral Forms
    • DFCS REFERRAL 2019.pdf
    • DFCS-Parent-Child-Relationship-Form.pdf
    • Medical-Office-Referral-Form.pdf
About Mosaic

Welcome to Mosaic Psychological Services. The mission of Mosaic Psychological Services is to provide quality mental health services to the people of this community and the surrounding counties. We hope to fill South Georgia’s need for excellence in psychological and therapeutic services in a dynamic way that honors the uniqueness of each family and individual that we serve.

Contact Info

Mosaic Psychological
229 Remington Avenue
Thomasville, GA 31792

Mailing Address
P.O. Box 378
Thomasville, GA 31799

Phone: (229) 233-8009
Fax: (229) 233-8037

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