Forms

If you were a patient of Dr. MacKillop’s while she practiced at Athens Behavioral Medicine and you are requesting a release of psychological records or documents to a third party:

1. Complete the release of information form
2. Send the completed form and the nature of the request in writing along with a $15 processing fee to Dr. Emily MacKillop at PO Box 48825, Athens, GA 30604.
3. Be advised that it may take up to 4 weeks to process your request and that additional fees may apply if a new report is required to be written or generated by Dr. MacKillop.

If you were a patient of Dr. MacKillop’s at the UGA Memory Assessment or Psychology Clinic, direct all questions to the staff professionals at the UGA Psychology Clinic by calling 706-542-1173. Or visit the website for more information: http://psychology.uga.edu/clinic/memory.php

The above forms are in Adobe Acrobat PDF format. You will need Adobe Acrobat Reader to view them. You can download it free here.