INTAKE FORMS

 

There are several standard clinical intake forms that I ask each new client to complete.  PLEASE COMPLETE ALL OF THE BELOW FORMS.

 

  • Patient Intake Form - This form is a fillable form and can either be completed directly from your computer or you may print it out and complete. To allow time for an Insurance Verification to be completed prior to our appointment, please forward this form after we have scheduled your appointment.  You may fax it to (301) 831-8958 or email to lplmedbill@hotmail.com.

 

 

 

 

 

So that we can spend your session time focusing on your concerns and not paperwork, I ask that you complete the below forms ahead of time. Clicking on the links below will open a PDF version of these forms in a separate window. Then you can print the forms directly to your printer, complete them at home, and bring them with you to the first appointment.