To allow me to gain information about you quickly and to expedite your first appointment, please fill out the following forms prior to your arrival. Clicking the link will prompt you to download the document. Please bring these forms to your first appointment. I will review them with you. Thank you.

  1. Office Policies
  2. Intake Form
  3. Notice of Privacy Practices (HIPPA)
  4. Signed Form to Show Receipt of HIPPA forms
  5. Insurance Form (This gives me permission to contact your insurance company.)
  6. Credit Card Form (Cash and checks are also accepted.)
  7. Biller Sheet

I would love to hear from you. Feel free to give me a call at 240-593-0444, email me at rose@rosecounselingcenter.com, or fill out the contact form below. Let me help you realize your full potential and bloom just like the strong and beautiful rose.

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