Switch to Accessible Site
Hands Holding Plant

Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session. If dually insured, please complete Client Psychotherapy Referral Form for Medicaid Insurance.

Please print and fax to (301) 429-6181 or email to cwray@alekshousemd.com.
(If you have additional pertinent information i.e. Medical reports, Discharge Reports etc. please fax/email as well.)


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.


Helpful Forms

Click here to view and print forms for your appointment.

Click Here