CLIENT FORMS

Click on the desired form to fill

Patient Registration Form

PHQ-9 Depression Assessment Form

Generalized Anxiety Disorder 7-item (GAD-7) scale Form

Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist Form

Patient Information Consent and Financial Policy Form

Controlled Substance Form

Release Receive Form

Initial Evaluation Form

Intake Form

Medication Consent Form

Mood Disorder Questionnaire Screener Form

Telehealth, Face-to-Face Treatment,and Medication:Education Consent Form

Self Pay Agreement Form

Termination Policy Form

Notice of Privacy Practices Form

OUR ADDRESS:

OUR ADDRESS & CONTACT:

3240 Belair Rd, Baltimore, MD 21213

443.759.9573

9:00 am – 5:00 pm

INSURANCE POLICY

We accept major insurances, including:

  • Medicare
  • Medicaid
  • Aetna
  • Tricare
  • Cigna
  • Humana
  • United Health Care
  • Carefirst and
  • Railroad Medicare