301-695-8390

Comprehensive Assessment
and Treatment For All Ages

Ambers Professional Center
170 Thomas Johnson Drive
Suite 200
Frederick, MD 21702

301-695-8390

PATIENT FORMS

New Patients

Scheduling Your First Visit

To inquire about a first visit, please fill out the Intake Request Form or call the Intake Coordinator at 301-695-8390 ext. 1

What to Submit Before Your First Appointment
To help make the most of our time together, please complete and submit the paperwork listed below using our secure forms.
Our Privacy and Patient Policy Documents
The following documents are yours to print and keep. You do not need to bring these to any appointment.

Current Patients

Prescription Refills
If you are a current patient and would like to request a prescription refill, please click here to access our secure online Prescription Refill Request Form.

If you prefer to phone in your request, our prescription refill line can be reached by calling: 301-695-8390 ext. 2

Miscellaneous Forms
At some point during your time with us, your therapist or psychiatrist may ask you to complete one or more of the forms below. Please do not complete and return any of these forms unless your therapist requests you to do so.


Go to our Payment & Insurance page for more information on how to plan payment for your first visit.


In accordance with privacy laws, the only forms that can be sent to us electronically are the forms we have made available for you to fill out and submit directly through our website.


ALL OTHER COMPLETED PAPERWORK CANNOT BE SENT TO US ELECTRONICALLY. Please download, print, complete and bring any other requested forms with you to your first appointment.