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DC Health Psychology, LLC

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Join date: May 17, 2022

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**NOTE NEW ADDRESS AND PHONE**

5560 Connecticut Avenue, NW

Suite 28A

Washington DC 20015

202-240-9102

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By checking this box to submit this form you indicate that you understand and agree to the following terms and conditions: The submission of this form requests an initial consultation with a clinical team member of DC Health Psychology. This initial consultation does not constitute the start of a professional relationship. This form is not appropriate for use in a crisis or emergency. Please call 911 or go to your nearest emergency room if you need immediate support. You are discouraged from sending detailed and sensitive personal health information using this form. We cannot guarantee your privacy and confidentiality using electronic communications. By submitting this form, you agree to accept the risks of transmitting your personal information via the internet and consent to being contacted via the methods you provide.

Thanks for reaching out. Someone from our clinical team will respond as quickly as possible, but usually within 48 business hours.