Forms and Documents

FMCS Patient Information Documents

Patient Registration Forms

If you are a new patient, you will need to complete the forms listed below. These forms are available to download and fill out prior to your appointment.

FMCS Registration Form

FMCS Consent for Treatment/Services

FMCS Receipt of Privacy Practices Written Acknowledgement Form

Client’s Rights and Responsibilities Statement

Sliding Fee Eligibility Form

Payment Agreement Form

Pediatric Health Care Forms

DC Medication Administration Form

DC Universal Health Certificate

DC Asthma Action Plan

Maryland Medication Administration Form

Maryland Sports Participation Form

Maryland Health Inventory Form

Maryland Asthma Action Plan

Maryland Lead Form

Pediatric Registration Form (12 Years or Younger)

Pediatric Registration Form (Older Than 12 Years Old)

Authorization to Release Child’s Information

Behavioral Health Care Forms

GAIN Short Screener Form

Patient Health Questionnaire and General Anxiety Disorder Form

PTSD Checklist for DSM-5