We need some information from you
New Patient Intake Forms
We work hard to avoid paper. Our intake forms are electronic and can be accessed from your phone or any computer or tablet.
We need you to fill out the online form at least one day before your appointment so that we can process it before you arrive.
Please allow 20-30 minutes to complete. For Medicaid patients, the form is a bit more involved. If you leave the form before you hit SUBMIT you will not be able to come back and start where you left off, so please try to find a time and place that will allow you to complete the form in one sitting.
If you have trouble using a computer or a smartphone to complete this form, one of our staff can sit down with you and collect all your information. Please let is know before you arrive for your appointment so we make sure that someone is available to help you.
Click on this link to get started online or click on the button below:
Maryland Medical Cannabis Program
For some of our patients with chronic conditions that are not responsive to traditional treatment, Medical Cannabis may be helpful. If you think you might be a good candidate, please visit the Maryland Medical Cannabis Commission (MMCC) website for more information. Please remember that no insurance company will pay for medical cannabis products from a dispensary.
If you think you are a good candidate, please register with the MMCC. It will take 1-6 weeks for the State to issue you a registration number. Once you get your number, please call us at (410) 220-0720 to make an appointment. Your medical cannabis assessment appointment cannot be combined with your MATClinics maintenance appointments. We need to see you separately. In addition, you will need to bring appropriate documentation to support your case. We can help guide you on what documentation we need when you call to make an appointment.
Before you arrive, please fill out our Medical Cannabis Intake Form. You can click on the button below to access the form.
Maryland Medicaid Form
If you are enrolled in Maryland Medicaid and want to be treated for your addiction to opioids, please fill out the form below. Unfortunately, you will need to do so every six moths. We encourage you to let your State Delegates (you have three) or State Senator (you have one) know that by requiring you to do this, the State is in violation of federal parity laws. You can find out who your State Delegates and State Senator are at this website and email them directly.
These laws were designed to reduce the barriers to mental health and substance use treatment. No one makes you fill out these kinds of forms when you see a practitioner for normal medical care. This is a transparent effort to reduce access to behavioral health care and we are frustrated on your behalf that the State forces us to impose these kinds of barriers to your care.