THE FORT CHRISTIAN PSYCHIATRIC CENTER
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Downloadable Forms & Information
DISCLAIMER:  Completing our 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 provided 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.  
​

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 virtual 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.*

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​
Christ-Centered 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. 
​
Shaw Wendi Fortuchang, M.D., FAPA
SPECIALIZING IN CHRIST-CENTERED,
​EVIDENCE-BASED TREATMENT OF FEAR & RELATED ANXIETY & MOOD DISORDERS

The Fort Christian Psychiatric Outpatient Center
Fayetteville, GA 30214
Phone: (770) 376-6726
*VIRTUAL TELEMEDICINE SERVICES ONLY

Open: 7am-7pm *Monday, Tuesday, Wednesday, Thursday
Appointments are on Tuesday, Wednesday & Thursday
*Monday is an administrative day

​**ALL SESSIONS ARE VIA TELEMEDICINE ONLY

Closed: Friday, Saturday & Sunday
Home
About Dr. Fortuchang
Services
Forms
Sessions & Fees

New Patient Appointment Request Form
FAQs
​Anonymous Patient Feedback

Appointment Cancellation
Curriculum Vitae for Dr. Fortuchang

The Fort Christian Psychiatric Outpatient Center...
Christ-centered psychiatry anchored in Biblical principles &
evidence-based medical science.

whoever does not love does not know god, because god is love! 1john 4:8

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The Prayer of Salvation
The Bible says, "But God demonstrates His own love for us, in that while we were still sinners, Christ died for us." Romans 5:8  That's the gift of salvation—the greatest gift of all!
How do we receive this gift? Romans 10:9-10 tells us, "If you confess with your mouth the Lord Jesus and believe in your heart that God has raised Him from the dead, you will be saved. For with the heart one believes unto righteousness, and with the mouth confession is made unto salvation." When we surrender our lives to Him, the result is peace, freedom from condemnation, joy, hope, and connection with God for eternity!

If you've never accepted the love and forgiveness that Jesus has to offer, there's no better time than now. I'm not talking about becoming religious and trying to be good enough; I'm talking about having a relationship with the Creator of the universe through His Son, Jesus Christ. It's so simple. 
Just pray this prayer from your heart: 
​"
Dear Jesus, I know I'm a sinner and I need a savior. I believe You are the Son of God, that You died, paying the price for my sins, and rose again. I ask You to come into my life. I receive You as my Lord and Savior."
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DISCLAIMER
The Fort Christian Psychiatric Center does not discriminate against anyone.  All are welcome. 
As an overtly Christ-centered, Bible-based practice, we (empathically and without judgment) allow God to use us as vessels to accomplish His will.
Copyright ©2014-2022 The Fort Christian Psychiatric Outpatient Center. 
Be joyful in hope, patient in affliction, faithful in prayer.  Romans 12:12
All information on this website is provided for general informational purposes only and should never be construed to be medical advice or treatment.
  • Home
  • About Dr. Fortuchang
  • Services
    • Children
    • Adolescents
    • Adults
    • Telepsychiatry / Telemedicine
  • Sessions & Fees
  • Forms
  • FAQ
  • Anonymous Patient Feedback
  • Appointment Cancellation
  • New Patient Appointment Request Form