Forms

Below is a directory of the forms that I have new clients read and sign.  The information release form is not always needed — it’s provided so you can see what the form looks like if you’ve had a doctor or therapist in the past whom I should talk with.

I have forms below for out-of-pocket/out-of-network clients as well as insurance clients (currently accepting Hopkins EHP and USFHP, CareFirst BCBS, Beacon Health / Value Options, Cigna, and Aetna).  

Out-of-Pocket Clients and Commercial Insurance Clients

(Private Pay, Out-of-Network, Johns Hopkins EHP and USFHP, CareFirst BCBS, Beacon Health / Value Options, Cigna, and Aetna)

Please bring these with you or be prepared to fill them out at your first session.  We should have already spoken via email or phone and agreed to an appointment before you fill these out.

Demographics and Financial Information   Credit Card Form
Background Questionnaire (Intake Form)   Information Release Form
Individual Therapy Agreement    PHI Notification Election
     

Hygeia Counseling Privacy Policy

Click here to download a copy of the current privacy policy.