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- Click on the link below to download a PDF of the Intake Form (6 pages)
- Please allow a few minutes for the form to download completely before attempting to type into it.
- When finished, click on the "Send by Email" button at the top of the first page to send electronically.
- If you're having trouble with that, you can also save the form to your computer to then send it as an email attachment
from your own computer.
- You can also print the form and fax it to 301-856-9459.
IMPORTANT: Please fax any medical reports/evaluation results to 301-856-9459. If you are
waiting for a report to be mailed to you, mention that in the "Comments" section of the Intake Form; then fax as soon as you
have received it.
Once you submit the form, you will receive an email confirming receipt and a phone call from the Intake Specialist; please
be sure to include all possible telephone numbers where you can be reached as well as email addresses.
Intake Form for Parents
Intake Form for Physicians, Social Workers
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