- RCC Baltimore - https://rccbaltimore.com -

Forms

pdf-icon-web [1]1- RCC Informed Consent [1]
This form is filled out by all new clients.

pdf-icon-web [2]2- RCC Insurance Demographics Form [2]

This form provides us with your insurance information to be returned via email or fax and can be filled out online here [3].

pdf-icon-web [4]3- Medical History Intake Form [5]

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

pdf-icon-web [6]

4- Release of Information Consent Form [7]

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

pdf-icon-web [4]5- RCC Couples Intake [8]

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

pdf-icon-web [4]6- RCC Couples Satisfaction Checklist [9]

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

pdf-icon-web [10]7- RCC Record Request [10]

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.