Patient Forms

Only after you have scheduled your appointment with one of our providers, your Client Registration information must be submitted in advance of your initial appointment.

Required Forms

In completing and submitting our Client Registration Online Form,  your registration information will be sent to us in a secure, encrypted manner; the information that you submit will be faithfully entered into our Account Management system.  This ensures accurate insurance and claim information.

Please complete all of the relevant fields, taking care to enter names, numbers, and dates accurately.  You will be prompted to complete any required fields.

Online Form

After you press ‘Submit’ at the end of the online form, you will be prompted to print, complete, and sign the Patient Agreement, and other forms that require a signature.  Please bring these with you to your first appointment.

To complete the Online Form, use this link:

Client Registration – Online Form

Printable Form

Alternatively, you can complete the PDF versions of these forms online, and then print a copy to bring with you to your appointment, or send it to us by confidential fax to 703.680.5011. 

To complete the PDF forms, use this link:

Client Registration – PDF Form

Occasional Forms

Your psychologist or therapist will let you know if you need to complete these forms:


Located midway between the communities of Manassas and Woodbridge, we are accessible to the Northern Virginia and Metropolitan Washington, DC areas.  We participate in several large insurance plans, and offer flexible hours to suit the demands of your busy life.  Our building and suite are fully accessible and ADA compliant.

All services are offered by appointment only.  Each of our providers maintains their own schedule so, after you have reviewed the information below regarding their areas of specialization, please reach out to them directly to discuss setting up an appointment.

Already have an appointment with one of our providers?  Be sure to complete the New Client Registration Forms prior to your appointment.