OCC Forms

Below you will find downloadable pdf files to print and complete prior to your appointment. Complete one set of forms for each patient being seen. For your convenience, you may pick up a set of printed forms at our offices in advance of your appointment. All documents are needed for your appointment, so be sure to complete in advance. Please carefully read and complete all necessary forms. Call us at 301-570-7500 if you have any questions.

New Patient Forms

New patients are required to complete the following forms and bring in a printed copy to your scheduled appointment at Olney Counseling Center. Please plan to arrive 15 minutes early for your first appointment so we can complete your registration.

New Patient Information
Packet 2018
LGSW Consent for Treatment, Confidentiality, & Financial Policy 2018
OCC Consent for Treatment 2018

Existing Patient Forms

These forms are intented for OCC existing patients. These forms should be used to provide OCC with updates information and authorizations.

Patient Conset Form 2018
Notice of Privacy, Practices,
& Confidentiality 2018
Consent for Treatment, Confidentiality, & Financial Policy 2018

Other Forms

Prior to your appointment, please contact OCC to confirm which forms you should download and complete from the list shown below. Bring a copy of the completed forms to your scheduled appointment.

Financial Hardship Application
and Instructions 2018
Multi-Party Authorization & Consent Form - Consent for Release and Exchange of Confidential Information
Credit Card Authorization Form 2018
Telehealth Consent Form 2018

Got Question?

Call us at 301-570-7500 to learn more about our services or request info here.