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How to make a referral: Please contact our office secretary and you will be prompted to complete an initial screening intake. This form includes reported demographic information and presenting problems. You can also print out the attached intake form and send to our office to begin the referral process. Once this information is obtained, insurance verification will occur and authorization will be requested from your insurance company. The secretary will promptly contact you to schedule an intake appointment with one of our licensed therapists in the office.
Please bring the following documents to your initial appointment:
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Birth Certificate
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Social Security Card
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Medical Insurance Card
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Copy of recent physical examination
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Copy of immunization records
**These documents are required per the State of Maryland Department of Mental Health and Hygiene requirements**
If you're a new client, please complete the following forms and bring them to your first therapy session.
OMHC
PRP/Respite
MSC
- In order to facilitate a smooth transition into the program, addition to the DSS 818 or the DJS Referral Packet the following items may be faxed to the agency in order to complete the intake process:
Attention: Program Administrator
Fax # (410) 742-6452
Commitment Order
Maryland Student Transfer Form
Immunization Record
IEP if receiving special education services
Social Security Card
Birth Certificate
Medical Assistance card or number:
For DJS individuals a certificate of placement is necessary.
Note: To download Adobe Acrobat Reader for free,click here.
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