FORMS TO REVIEW BEFORE OUR FIRST APPOINTMENT

Great things start with a single step

Please review the forms below before your first appointment so you can become familiar with my office policies.  I am happy to discuss any questions you might have before we meet or during our meeting(s).

Filling them out ahead of our first session will allow us to make full use of our initial session.

  1. Client Data Form
  2. Client Therapist Agreement
  3. HIPPA Privacy Information Form
  4. Authorization for the Release of Information

NEW! In this current Covid-19 pandemic, I am fully equipped to bring my services to you via teletherapy, or distance therapy. Here’s the form:

Telehealth Therapy Services Consent Form

I am looking forward to working together.

At the conclusion of, or during our work together you could help me learn what you think I am doing well and what could use improvement. Please fill out and return this Client Satisfaction Survey to me.

 

Get in touch.

I'm always happy to hear from people.
If you have any questions, need more information, or would like to make an appointment, you can call me at 301-279-7779, email me at [email protected], or use the form below.

I occasionally see clients using a video-chat platform called VSee. It is free to download and easy to use. Please ask me about that option, if you are interested.
Learn more.

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About Beth

Licensed Clinical Social Worker • Over 15 years of experience • Certified Emotionally Focused Couple Therapist and Supervisor • Member of The Greater Washington Society of Clinical Social Work • Member of the International Centre for Excellence in Emotionally Focused Therapy • Member of Clinical Social Work Association • Member of National Association of Social Workers

© 2017 Beth Levine Site Design by Tim Kenney Marketing

Serving All of Maryland through teletherapy, including Rockville, Bethesda, Chevy Chase, Kensington, Gaithersburg, Germantown, Potomac, Silver Spring
Phone: 301-279-7779
[email protected]

Hours by appointment only

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