Becoming a new patient



Completing the new patient intake form





Please complete the intake form below and click submit. The form below includes necessary information required for an initial patient intake. It is very important to complete the entire intake form so we may better serve you. If sections of the form are left blank, it may not submit. Upon receipt of your intake form, a staff member will contact you within 24 hours or the next business day to discuss scheduling and treatment needs.



the day of your appointment





On the day of your initial appointment, please arrive 30 minutes early to review and sign all initial patient documents and get checked-in. You will need to bring photo ID, your insurance card(s), and a method of payment for your copay, should you have one. All copays are due at the time of service. We accept Visa, Mastercard, Discover, cash, and certified funds. All checks are subject to fund verification.



Scheduling initial appointments





Upon scheduling an initial appointment, our staff shall make every effort to meet the various needs of patients. Please notify staff of scheduling conflicts and we will attempt to accommodate your needs. Forming a connection with your therapist may take a few sessions, but if you are not satisfied with the services provided, please notify the front support staff and/or request a New Patient Survey. The Executive
Director will contact you to assist in resolving the issue.



Cancellations & no-shows





If you need to cancel or reschedule an appointment for any reason, you must provide at least two hours notice. If you are unable to provide two hours notice for a cancellation, your appointment will be marked as a "no-show" including a fee of $75.00. Canceling and rescheduling appointments may cause delays in treatment, therefore it is best to make every effort to keep scheduled appointments.

** When canceling appointments that are scheduled before 11AM, must be communicated to agency via email/voicemail before midnight the night prior to the scheduled appointment.



New Patient Intake Form





feel free to contact us with questions or comments!



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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CALL TODAY: 410-758-8750

outpatient BEHAVIORAL health AGENCY



207 N. Liberty st. ste. b, centreville, md. 21617