Forms

Please check with your therapist regarding forms needed for the intake session. 

For your convenience, you can download, fill out, and print a form (PDF) in advance of your visit.

Client History Form - Child

Contact Form

Client History Form - Adult

HIPPA - Notice of Privacy

Practices

Acknowledgment of Receipt of HIPPA - Notice of Privacy Practices

Electronic Communication

Consent & Release Form

There is hope, we can help ~ solutions for life's challenges.

Deborah accepts Care First - Blue Cross, Blue Shield Insurance.

Maggie will meet with clients for a reduced fee. Please contact her for more information.

Loretta accepts Care First, Blue Cross/Blue Shield, Cigna and Medicare Insurance.

Contact Kelly regarding current insurance.

9675 Main Street, Suite C
Fairfax, VA 22031

Tel: 703-899-8222