We are preparing to offer services via telehealth.
Please print and complete this Telehealth Release & Agreement Form with signature.
Send to [email protected], fax to 410-548-3341 or drop it at any office location during business hours.
We have forms at the office for patients who do not have access to print and send back to us.
We need this form signed to provide services via telehealth.
If you're a new client, please complete the following forms and bring them to your first therapy session.
- Client Psychotherapy Intake Form
- Limits of Confidentiality/Therapy Cancellation Policy
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
- Authorization to Disclose Information Form
|Client Psychotherapy Intake Form|
|Limits of Confidentiality/Therapy Cancellation Policy|
Note: To download Adobe Acrobat Reader for free, click here.