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887 B Rio East Court Charlottesville, VA 22901 Phone: (434) 220-4686 Fax: (434) 220-4687
Serving the mental health needs of Virginia's families
Please come 15 minutes early for your first appointment.
Forms
Patient Information and Informed Consent Form
Patient Registration
Child/Adolescent Intake Summary (Parent Questionnaire)
Adolescent Informed Consent Form
Fees
Summary of Financial Responsibility
Contract for Payment
HIPPA and Privacy Practices
