Resources
Below are forms some of which need to be completed prior to the first session. Please discuss which forms to complete with Dr. Mazza before your appointment. The completed forms can be brought with you or emailed to Dr. Mazza in advance.
The forms are easy to fill out. Just move your cursor to a blank space on the form and start typing. Once everything is filled out, click on the save icon on the upper left and save it to a location on your computer you can easily find later.
Some of the forms such as the “New Patient Information” form should be completed prior to our first session. You may also print out and review the “Treatment Agreement” form and the “Confidentiality Agreement”, as you will be asked to sign those at the first session after we discuss any questions you might have. The “Brief Health Information” form is a useful way for you to summarize your health history and is helpful to have filled out prior to our first session.
You will need to have Adobe Acrobat Reader installed on your computer to view the forms. If you do not have it, you can download it for free here.
- Authorization to Release Protected Health Information
- Brief Health Information form
- Confidentiality Agreement
- New Patient Information form
- Request for Confidential Handling of Health Information
- Treatment Agreement and Notice of Policies and Procedures to Protect the Privacy of Patient's Health Information
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* No appointments are confirmed until you have spoken with Dr. Mazza.
The Center for Problem Solving
7112 Armat Drive
Bethesda, MD 20817
P: 301-469-7200
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