Electronic Signature Forms

The following forms may be completed electronically prior to your appointment.

*Please note that only applicable office staff will have access to any information provided using these forms. 

Registration Packet -        This form includes our base registration packet along with the telehealth agreement, which is important                                                          due to the majority of providers participating in telehealth appointments. 

Release of Information - Your provider may have asked you to complete an "ROI". This form gives us permission to coordinate                                                              treatment, receive past treatment records, or discuss appointment status with places or individuals of                                                              your choosing. 

Credit Card Authorization Form

Letter Request Form

​Telehealth Agreement

​Submission Form

Call Us:  410-766-6624

M & M Behavioral Health Solutions

Printable Forms

​The following forms may be printed out and completed. Then you may scan and upload files to the form below. 

Registration Packet

Release of Information

Credit Card Authorization form

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