About Us
Questions?
- Can You Help Me?
  What Treatment Services Can We Provide?
  Where are Services Provided?
  What Payment Options and Insurances Are Accepted?
  How do I get an Appointment?
Resources
Contact Us
Reports
- Quality Performance Reports
  Archived Reports
Opportunities
- Career Opportunities
  Positions Available
  Submit Your Resume

Specialized Behavioral Health Services

How do I get an Appointment?

Complete the referral form below...
or contact us at 478-333-2498
or 478-333-6197 for assistance.

Dynamic Interventions

Youth's Information

First Name

Last Name

Living Address

City

State

Zip Code

Date of Birth

Gender

Male Female

Race

Social Security Number

Medicaid Number

Is Youth enrolled in Special Education?

Yes No

Is Youth receiving SSI/Disability income?

Yes No

Parent/Guardian information

First Name

Last Name

Home Phone

Work Phone

Relation to child

Cell Phone

Parent/Guardian Email Address

Agency Information

Referring Agency

Agency Contact Person

Phone Number

Agency Phone Number

Referral source email address

Has Psychological Evaluation been completed?

Yes No

Reason for referral

Referral Info

How did you find out about Dynamic Interventions?

Other:

Medications

Psychiatrist

Diagnosis

Please fax verified diagnosis document (if available) to 478-333-6531

Previous mental health treatment

Crisis Stabilization

Facility

Approximate date

PRTF

Facility

Approximate date

Outpatient Therapy

Agency

Approximate date

Intensive Family Intervention (IFI)

Agency

Approximate date

No previous treatment

Type both words or set of numbers you see into the box above. One of the words can be difficult to read,
just do your best and it should be accepted as long as you get one correct.

Contact Us:

524 South Houston Lake Road

Suite G-100

Warner Robins, GA 31088

Phone: 478-333-2498

Fax: 478-333-6531

409 EH Court
Brunswick, GA 31520

Phone: 912-342-7064

Fax: 912-342-7432

Three Year Accreditation

Intensive Family-Based Services:

Mental Health
(Children and Adolescents)

Outpatient Treatment: Integrated:

AOD/MH
(Children and Adolescents-April 2014)

Office Hours:

Mon:	9am to 5pm
Tue:	9am to 5pm
Wed:	9am to 8pm
Thurs:	9am to 5pm
Fri:	9am to 5pm
Sat:	By Appointment
Other:	By Appointment

About Us:

Our Story
Can You Help Me?
History
Our Dynamic Partners

Links:

Career Opportunities
Client Referral Form
Email Login
Employee Training Website

Mission Statement:

Provide the highest quality home and community-based mental health treatment services available to Georgia's youth and their families.

524 South Houston Lake Road, Suite G-100 Warner Robins, GA 31088
Phone: 478-333-2498 Fax: 478-333-6531

Copyright © 2016 Dynamic Interventions, Inc.. All Rights Reserved.

About Us
Questions?
- Can You Help Me?
Resources
Contact Us
Reports
- Quality Performance Reports
  - Archived Reports
Opportunities
- Career Opportunities
  - Positions Available
  - Submit Your Resume