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Forms

New clients, please complete the following forms and bring them to your first appointment (intake session).

Dr. Mary A. Ellis is an Carefirst Blue Cross/Blue Shield insurance provider. Please complete following forms should you wish to receive coverage under this plan.

To coordinate treatment with another clinician/physician and/or consent to discuss clinical issues with those in position to clarify same (such as teachers and parents/guardian, if you are older than eighteen), please complete following form.

Kindly arrive twenty minutes early to complete requisite documentation not otherwise received as attachment with clinical intake appointment email.

 

 

 


Note: To download Adobe Acrobat Reader for free, click here.

 

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