410-5-EVANS-5 (410-538-2675)

1009 Frederick Rd., Catonsville, MD 21228

 

 

Trent Evans, Ph.D.

Clinical Psychologist

INTAKE FORM

 

OUTPATIENT SERVICES CONTRACT

 

NOTICE OF PRIVACY PRACTICES

 

CHILD/ADOLESCENT CONTRACT

 

Please click above to download these forms.  Please complete the intake form (which is a fillable PDF) and email it to me prior to our first meeting.  If you are unable to email it, please print it out and bring it with you. Also please read the Outpatient Services Contract and ask me any questions you may have about it when we meet.  Please also read the Notice of Privacy Practices which describes how your privacy is managed under HIPAA (Health Insurance Privacy and Portability Act of 1996).  Print and sign the Child/Adolescent Contract if you are bringing in your child under age 18.