COVID-19 Safety Measures

Patient Portal

info@mentalhealthbaltimore.com | 443-396-2419
Become a Patient
banner image

Legal Forms

Thank you for choosing us for your mental, social, and emotional needs. To complete new patient intake please review and sign the legal forms below. If you require assistance or have questions, please call email us at ino@mentalhealthbaltimore.com. 

  1. Adult Authorization for treatment 


  2. Pediatric Parental Authorization for treatment


  3. Authorization for telehealth


  4. Authorization for information exchange


  5. Authorization to bill insurance


  6. Notice Privacy Practices & Patient Rights


Contact
logo

443-396-2419
info@mentalhealthbaltimore.com

One North Charles Street, STE 2425
Baltimore, MD 21201

Send a Message

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.