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.
- Birth Certificate
- Social Security Card
- Medical Insurance Card
- Copy of recent physical examination
- Copy of immunization records
If you are interested in services, please contact the intake coordinator at the Wicomico or Somerset offices.
Renee Carlins at Somerset Clinic 410-968-3547
MHVP Referral Form 2017
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