Secure Message and Secure File Transfer

Cahaba Psychology Center

This form allows you to send confidential information and to upload files for confidential transfer to our front desk staff. Information for your psychologist will be routed to them.

Telephone: 205-403-0955

Please make my message attention:

Dr. Mark Burge Dr. Pattie Jolly-Fleece Front Desk Staff

Your name

Email address

Please send me:

Release of Information Form

Patient-Therapist Agreement

Financial Agreement

Telepsychology Agreement

Secure Message

Files You can add multiple files

Add file

Please upload a file

Your information will be encrypted.