Patient Form
Patient Orientation
Patient Form
Patient Orientation

Author name: bridgesbehavioral

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Monday – 8am – 6pm
Tuesday – 8am – 6 pm
Wednesday – 8 am – 6 pm
Thursday – 8 am – 6 pm
Friday: By appointments only

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Hours of operation

Our building is handicap accessible at rear entrance.

Monday: 8am – 6pm
Tuesday: 8am – 6 pm
Wednesday: 8 am – 6 pm
Thursday: 8 am – 6 pm
Friday: By Appointments only

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New Patient Intake Form

Please complete the form in its entirety. If a section does not apply to you, please enter “N/A” in the box. Please ensure your phone number is entered correctly, as this is how we will contact you for your appointment. Please answer each item as truthfully as possible. All information entered in the New Patient Intake Form is kept strictly confidential.

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Patient Orientation

Important Points:

If an emergency arises, please call 911. We request 24 hours notice when canceling appointments. All appointments canceled with less than 2 hours notice will be subject to a no-show fee of $75.

Information regarding patient treatment is kept strictly confidential unless one of the following is present: an authorization to disclose/exchange information with specified individuals, an imminent threat on a patient’s safety is perceived, the patient threatens another individual’s safety, or a medical emergency arises. In any case, we make every effort to protect your privacy and health records.

Families are important to us. We encourage family involvement in treatment, especially if treatment is being provided to a patient under the age of 18.

Patient Bill of Rights and agency standards are offered at the initial appointment and are available to patients upon request.

Treatment Issues:

In the event of an after-hours issue that is unrelated to appointment changes, scheduling, or medication refills, patients may contact Bridges’ after-hours on-call service at 410-490-0209

  • A patient may be subject to discharge for treatment non-compliance, assaultive behaviors, drug seeking behaviors, etc. Please see Discharge Notice for further information. To file a complaint or grievance, the patient may inform our front staff so they may provide assistance, or the patient may retrieve a grievance form from the bulletin board in our waiting area. Grievance forms may be returned to our office in-person or by mail. Upon receipt of a grievance, the Executive Director will reach out for resolution. If you are still unsatisfied upon resolution of your grievance, you may file an appeal in writing and submit it to our agency for review.

If you are not satisfied with your treatment or feel that you are not forming a connection with your therapist, please inform our front staff so that we can make accommodations or transfer you to a different clinician.

Safety Measures

Tobacco use is not permitted in front of our building or inside the agency building. Illegal drug use and alcohol use is prohibited on agency property. Law enforcement will be contacted if a safety issue arises.

Weapons are prohibited on agency property (does not apply to law enforcement officials).

Bridges’ has three exits; two in the front of the building and one in the rear of the building, which is handicap accessible.

In the event of a fire or emergency evacuation, please reference building maps (located at the doorway of each office) for the nearest exit. Fire extinguishers are located at each of the three exits, and the break room.

A first-aid kit is located in the front office.

Please notify a staff member if you are in need of medical attention.

In the event of an emergency, call 911.

HOURS OF OPERATION

Monday: 8:00am-6:00pm

Tuesday:  8:00am-6:00pm

Wednesday: 8:00am-6:00pm

Thursday: 8:00am-6:00pm

Friday: By appointments only

Maryland Suicide and Crisis Lifeline

Text or call at 988

New Patient Orientation

Please retain this information as a reference guide for questions related to treatment and important agency policies.

T: 410-758-8750

F: 410-758-8751

After hours on-call: 410-490-0209

email: staff@bridgesbehavioral.com