Please stop and read the COVID-19 Statement & FAQ pages now.  Thank you.

If you have already read the FAQs page and would like to continue forward for an initial evaluation, then please do the following: 

1. First, call our office at 770-376-6726 to schedule an appointment.  Then...
2. Please print and fill out (in entirety) the appropriate initial evaluation packet, and bring it to the appointment.  Please provide an honest answer for each and every question.  It is extremely important that these forms be completed prior to the evaluation.  Not doing so will delay the start time and may result in forfeiture of the appointment, at full cost to you.
3. ​*Please do not wait until the last minute to complete the paperwork.
4. ​Please bring a government-issued form of photo identification with you.
5. Please bring the bottles of any and all medication you are currently taking on a regular basis, even if prescribed by your primary care physician.  ** Herbal supplements and "over-the-counter" medication should be detailed in paperwork but does not need to be brought to the appointment.**
6. When applicable, please bring copies of any child custody agreement / legal guardianship paperwork with you to the appointment. 
7. Please bring copies of any additional historical information you may have (previous doctor's notes, therapist's notes, lab results from blood work, etc).
8. ​Please remember to bring your method of payment (cash, check, credit/debit card, health savings/flexible spending card).   ​

Office Location:

The Fort Christian Psychiatric Outpatient Center
110 North Park Drive
Fayetteville, GA 30214
Phone: (770) 376-6726
*Appointments are via telemedicine only

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Office Hours:

Mon: CLOSED
*Tues: 7am - 7pm
Wed: 7am - 7pm
Thurs: 7am - 7pm
Fri: 7am - 7pm
Sat: 7am - 7pm
Sun: CLOSED
*Appointments are via TELEMEDICINE only
Appointments are on Wed, Thu, Fri & Sat
*Tuesday is an administrative day

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DISCLAIMER:  Completing intake forms does not guarantee an appointment.  A doctor-patient relationship is not established until the decision to create one is made at the conclusion of the initial psychiatric diagnostic evaluation.  Therefore, a person does not become a patient of Shaw Wendi Fortuchang, M.D., PC / The Fort Christian Psychiatric Center (or its associates) until decided so by Dr. Fortuchang.  
​Prescriptions are only given once a person becomes a patient. 

**We routinely check the prescription history of every potential (and existing) patient via The Prescription Drug Monitoring Program.  This extremely important safety measure is mandated by The Georgia Composite Medical Board, The Georgia Department of Public Health, The Georgia Psychiatric Physicians Association, The American Psychiatric Association and The American Medical Association.  
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IMPORTANT: *If it is determined that you are not a fit for our practice, or that a more acute level of care is required (ie: crisis stabilization via hospitalization, partial hospitalization or intensive outpatient services), and our outpatient services are insufficient for your needs, we will notify you immediately.  
​We are not an acute care facility and we do not provide such services.*

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INITIAL EVALUATION FORMS

​Credit Card Authorization Form
HIPAA Notice/Patient Notice of Privacy Policies​
Adult Packet - ​​​​​​​​​​​FEMALE
 Adult Packet - ​MALE
Child/Adolescent Packet - ​​​​​​​FEMALE
Child/Adolescent Packet - MALE
​Adolescent Questionnaire
​Office Policies, Protocol & Procedure
​Pearls of Wisdom - ADULT
Pearls of Wisdom - CHILD & ADOLESCENT
Procedure Codes for Billing Insurance 
Procedure Code Algorithm for Billing Insurance
Release of Information Form ADULT
Release of Information Form CHILD/ADOLESCENT
Tele-Psychiatry Consent Forms for New Evaluations​
TFCPC Procedure Codes  
​Vanderbilt Assessment Scale- Parent
​​​Vanderbilt Assessment Scale- Teacher 
Vanderbilt Assessment Scale- Parent Follow-Up 
Vanderbilt Assessment Scale- Teacher Follow-Up 
​​​Spirituality Questionnaire

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ESTABLISHED PATIENT FORMS

Becoming FORTIFIED in The Lord
Benefits of Change Worksheet​
Christian Mindfulness Meditation
​​​Confessing and Believing God's Promises for Your Life!
Credit Card Authorization Form
CY-BOCS- Parent Report
​Daily Mood Tracker
​​​​​​​Dealing with Negative Thoughts Worksheet
ERP Homework Sheet
Fervent Prayer
​​​Forgiveness Prayer
General Consent Form- ADULT
General Consent Form- CHILD/ADOLESCENT
Insurance Reimbursement Form & Information
Office Policies, Protocol and Procedure
Release of Information Form ADULT
Release of Information Form CHILD/ADOLESCENT
Tele-Psychiatry Consent Forms for Established Patients
Therapeutic Bath Soak Recipe

"If you can't fly, run; if you can't run, walk; if you can't walk, crawl; but by all means keep moving."  
                                                                                             Reverend Dr. Martin Luther King, Jr. ​