Health Forms

Prior to your initial visit, please complete the health form and the consent form found below, and email the scanned forms to:

info.gwcim@gmail.com 

or fax to:

202-478-1738, or mail it to us.

We will call you within 48 hours after our Medical Director has reviewed the forms to set up the first evaluation appointment. Please contact us if you do not hear from us to make sure that your form has been received.

We look forward to meeting you.

HEALTH FORMS

[Note: The forms are viewed and printed using Adobe Acrobat Reader, included with most computers. If you do not have a copy, go to http://get.adobe.com/reader/ for a quick, easy and free download.]

PRINT AND SEND TO US:

or Pediatric Patient Health Intake (under 12 years old)

Cancellation Policy

When you need to cancel an appointment, we would appreciate your consideration for our providers’ time that has been set aside for you, and for the time to review your medical history that you sent us.

If you cancel less than two business days prior to the initial appointment (48 hours, Saturday for a Monday appointment), there will be a charge equal to 100% of the provider’s fee.