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Recovery Counseling Center

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Forms

pdf-icon-web1- RCC Informed Consent
This form is filled out by all new clients.

pdf-icon-web2- RCC Insurance Demographics Form

This form provides us with your insurance information to be returned via email or fax and can be filled out online here.

pdf-icon-web3- Medical History Intake Form

This form is filled out before your first medication management appointment.

pdf-icon-web

4- Release of Information Consent Form

This forms grants permission for us to share or receive information from another person regarding your case.

pdf-icon-web5- RCC Couples Intake

This form is for couples to fill out and submit before beginning counseling.

pdf-icon-web6- RCC Couples Satisfaction Checklist

This form is for couples to fill out and track progress with their therapist.

pdf-icon-web7- RCC Record Request

This form is for clients requesting their records. We require up to 30 days to process. Postage and any other fees are the client’s responsibility.

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CONTACT US

RECOVERY COUNSELING CENTER, LLC
2833 Smith Ave #419
Baltimore, MD 21209

443-681-9150
1-877-715-7229
Office@RCCBaltimore.com

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