Helpful Forms

COVID-19  Precaution Protocol For In-Person Visits

1. Clients and guests must wear a face mask when entering and exiting Ruxton Towers.

2. Face masks are required for clients and guests in the reception areas.

3. Clients and guests are required to take their  temperature and complete the COVID-19 form upon entering PCCC's reception areas.

4. Please do not schedule an in-person visit if you have traveled out of Maryland in the past two weeks; have experienced any cold or flu-like symptoms in the past 14 days; or have had close contact with or cared for someone diagnose with COVID-19 within the past 14 days.  If you answer yes to any of the questions, please do not come into the office.  You are welcomed to schedule teletherapy sessions with your therapist.


Forms for Therapy Services

Appointments can only be scheduled once all intake forms have been completed and submitted.  Please submit your completed forms within 48 hours of the intake phone call.

  • Please complete  "New Client Intake Form" prior to the first appointment.  The forms can be completed online and will be submitted directly to our Intake Coordinator.
  • Please send a copy of your insurance card and driver's license to [email protected].
  • Please send EAP authorizations to [email protected] when using an EAP. If the EAP authorization is not received prior to the first session,  client will be responsible for the standard out of pocket rate for each session.
  • Please be prepared to pay for your appointment at the time of service.  We accept credit, debit and HSA cards.  Checks and cash are accepted in office.  Payment through the client portal is also an option.
  • Please understand that our clinicians are not able to be involved in custody or legal disputes/proceedings.

 

Digital Forms

 

Printed Forms


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