Intake FormsAmyAdminCABC2021-08-20T10:48:34-04:00

Intake Forms

The following forms will be provided to all new clients prior to the first session with a clinician.

New Patient Information Packet
Credit Card Authorization Form
Privacy Notice
Release of Information Form
Outpatient Services Agreement (Consent)
Billing & Fees Agreement
Parent of Child Screening Forms
Telehealth Agreement

Dear Valued Clients:

The Center for Anxiety and Behavioral Change is continuing to limit our services to telehealth services. Please know that we are looking forward to return to in-person therapy. We are closely monitoring the level of community spread of COVID-19, the local and regional vaccination progress, and the evolving guidance from the Center for Disease Control (CDC) and the Maryland and Virginia Departments of Health. We are working diligently on a plan for gradual return to in-person services and will provide more information as soon as we are able. Thank you for your patience.