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. 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 the button below to get started:
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.