Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Note: To download Adobe Acrobat Reader for free, Click here.

CloverLeaf Counseling Services

Address

6790 Crain Hwy,
LA PLATA, Maryland 20646

Office Hours

Monday  

10:00 am - 1:00 pm

5:00 pm - 8:00 pm

Tuesday  

10:00 am - 1:00 pm

5:00 pm - 8:00 pm

Wednesday  

10:00 am - 1:00 pm

5:00 pm - 8:00 pm

Thursday  

10:00 am - 1:00 pm

5:00 pm - 8:00 pm

Friday  

Closed

Saturday  

8:00 am - 1:00 pm

Sunday  

Closed