Blue Ridge Behavioral Health

 

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.

• 1. A completed, signed and dated Patient Registration Form
• 2. A signed and dated Financial Agreement
• 3. A completed, signed and dated Billing Authorization Form  (to be completed by Patients 18 years and older who have someone else taking responsibility for payment, such as a parent/guardian)
• 4. A signed and dated Patient Policies, Privacy Practices, and Patient Rights and Responsibilities Form
• 5. A completed, signed and dated Evalulation Form: (choose just one):
  • For Patients 18 and older - Adult Evaluation Form   OR
  • For Patients 17 and younger - Child / Adolescent Evaluation Form (to be completed by a parent/guardian)
• 6. A signed and dated TeleHealth Consent Form
• 7. A completed, signed and dated Email Consent Form
• 8. A signed and dated Notice of Fees

 

For Neuropsychological Testing

• 1. A signed and dated Testing Consent Form
• 2. A signed and dated Notice of Fees for Testing

 

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.

• Blue Ridge Privacy Notice

 

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.