Personal Empowerment in Rockville, Maryland

• Patient Registration Forms:
  • Patient Registration Form
  • PHQ-9 Depression Assessment Form
  • Generalized Anxiety Disorder 7-item (GAD-7) Scale
  • Adult ADHD Self-Report Scale (ASRS-V I. I) Symptom Checklist
  • Mood Disorder Questionnaire Screener
  • Medication Consent Form
• Controlled Substance Form
• Notice of Privacy Practices
• Patient Information Consent and Financial Policy
• Intake Form
• Release Receive
• Termination Policy
• Self Pay Agreement
• Screening Form
• Initial Evaluation Form
• You First Health and Wellness Services LLC Signed
  • Telehealth, In Person Treatment, and Medication/Education Consent Form