Client Forms

If you’re a new client, please complete the following forms and bring them to your first therapy session.

Client Registration Form
Disclosure Statement
Office Policies and procedures

Additional forms regarding HIPAA, and appointment reminders are below :

HIPAA
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
Note: To download Adobe Acrobat Reader for free, click here.

 

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21945 Three Notch Rd. Ste 103
Lexington Park, MD 20653

admin@innerpeacets.org
(301) 866-6333

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