THE FORT CHRISTIAN PSYCHIATRIC CENTER
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NEW PATIENT APPOINTMENT REQUEST FORM

*VIRTUAL TELEMEDICINE APPOINTMENTS ONLY
Appointments are on Tue, Wed & Thu
*Monday is an administrative day
CLOSED Fri, Sat & Sun


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TFCPC Appointment Request Form

    **This form is not HIPAA-compliant.**
    **Please call our office at 770-376-6726 if you prefer to answer these questions via telephone**  

    However, If you are comfortable with completing and submitting the form below, then please continue.  Every item requires an answer, so please read each question very closely before answering.  Write N/A in the text boxes for items not applicable to you.  Please remember to click the SUBMIT 
    button when done.  Once we have reviewed your form, we will contact you by telephone to complete the scheduling process.  Afterward, you will receive a confirmation email with required paperwork attached to it.  We must have these completed documents in our possession before you may be seen.   Forms submitted outside business hours will not be reviewed or responded to until the next business day.  We are open Monday through Thursday from 7 AM until 7 PM.  Thank you.
    **For emergencies or safety issues, either call 911 or go to the nearest emergency room.**
    Please note that we do NOT accept insurance or bill insurance companies.
    Please note that we cannot accept patients using Medicare, Tricare, Peachcare, Medicaid
    Please note that some situations are not appropriate for telemedicine.
    Please note that we do not treat substance use disorders.
    Please note that we do not treat Schizophrenia or psychotic disorders.
    Please note that we do not treat ADHD.
    Please note that you must be in the state of GA to receive our services.
    Please visit our FAQ page or our Services page for more information.

    **PLEASE READ: This form is only for people seeking our clinical services (doctor-patient, consultation or 2nd opinion). It is not intended for people seeking forensic psychiatry evaluations.   Instead, please call our office.  Thank you.









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    **STOP** If you answered YES to this question please discontinue completing this form.  Instead, please call our office to learn more about our forensic psychiatry services.  This form is only for people seeking clinical services. Thank you.**
    **STOP** If you answered YES to this question please discontinue completing this form.  Instead, please call our office to learn more about our forensic psychiatry services.  This form is only for people seeking clinical services. Thank you.**
    **STOP** If you answered YES to this question, then please discontinue completing this form.  Instead, please contact a mental health provider who specializes in substance abuse/dependence.  We do not offer such services. Thank you.**
    **STOP** If you answered YES to this question and you are still struggling with substance abuse/dependence, then please discontinue completing this form.  Instead, please contact a mental health provider who specializes in substance abuse/dependence.  We do not offer such services.   However, if you are in recovery and substance abuse/dependence is no longer an issue for you, then please continue with completing this form. Thank you.**
    **STOP** If you answered YES to this question and the attempted suicide was recent, then please stop completing this form.  Instead, please either go to your local ER or contact a psychiatric hospital.  We are not an acute care facility.**
Submit

Thank you!  May the face of God shine on you and give you everlasting peace!


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Redemptive healing for your soul, mind, body & spirit...
​
770-376-6726

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
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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