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Pre-Trial Intervention Diversion Program Of Georgia
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Intake form
Help us serve you better
Name
*
Email address
*
Phone number
Date of birth
Address
Reason for seeking intervention
Please select at least one option.
First-time offense
Substance abuse
Mental health issues
Financial difficulties
Preferred method of communication
Select
Phone
Email
In-person visit
Have you been previously enrolled in a diversion program?
Select
Yes
No
Referral source
Which service or services are you interested in?
Please select at least one option.
Court appearance assurance
Compliance monitoring
Administrative fine management
Initial consultation for $150
Follow-up consultation for $100
Additional questions or comments
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