New Client Forms
Click on the boxes below to find the PDF forms available to download. Read each form carefully before signing. Your therapist can answer questions about them at your first appointment.
The Center must have a communications address and billing address for you (and a home address if different from the other addresses).
Also, please complete other demographic information, which is held in confidence and only provided in aggregate form to funders of The Center.
Please read the Services Agreement carefully. After the form is completed by your provider, sign it and give it back to your provider.
*For clients under 14, a parent or guardian must sign the form.
You must complete a financial arrangements form, indicating who is responsible for fee payments. Also on this form, optionally for your convenience, you may set up a credit card account.
Minor Consent – Virginia
For clients at our Viringia location that are under the age of 18, a parent or guardian must fill out this form.
Minor Consent – DC
For clients at our DC location that are under the age of 18, a parent or guardian must fill out this form.
Notice & Acknowledgment of Privacy Practices
Please thoroughly review the notice of privacy practices and complete the form to acknowledge your receipt of this notice.
Please give the signed acknowledgment to your provider.
Insurance Form for Clients of Licensed Therapists
If you are seeing a licensed therapist and wish to have The Center submit insurance claims, you must complete these insurance forms.
If you have questions about using insurance, please call our Insurance Department at 703-281-2657 #234.