-
New Patient
 
 
If you are a new patient and would like to schedule an appointment,
you may call the office or fill out the Initial Contact Form and submit to us electronically. Once we receive your electronic request out staff will contact you to coordinate the date and time of your appointment. The electronic submission of essential patient's information is preferred due to high volume of incoming calls which sometimes could be associated with extended waiting time.
 
We are also requiring the completion of "Patient Agreement and Credit Card Info" forms  prior to scheduling your Initial visit.  Office staff will provide you with electronic or paper version of the agreement. Also please fax us copy of your picture ID at (410) 535-1029.
 
INITIAL CONTACT FORM
Your Name
Date of Birth
Home Address
Home phone
Cell phone
Work phone
E-mail address
Insurance Company
Insurance phone number
Why do you need to be seen?
Type of services:
General Psychiatric Evaluation and Treatment
Individual Psychotherapy
Couples or Family Therapy
Group Therapy
Buprenorphine Treatment for Opioid Dependence
Fit for Duty Psychiatric Evaluation
Psychiatric Evaluation for DSS and HS
Evaluation for Treatment with ECT
Evaluation for Treatment with TMS
Psychiatric Evaluation for Gastric Bypass Surgery
Psych. Evaluation for General or Plastic Surgery
Yoga
You have to arrive 15-20 minutes early for the initial evaluation to fill out the paper work. Thirty and more minutes  late for the initial evaluation will result in cancellation of your appointment and appropriate missed/ late cancellation fee will be applied.