CCACC Health - Mental Health Intake Form
Please understand that this online form does not include the Authorization for use and disclosure of medical information form and the privacy notice acknowledgement form. You will still be require to sign this form.          
If you have any questions, please reach out with us 240-393-5950
请理解，此在线表格不包括医疗信息使用和披露授权表和隐私通知确认表。 您仍需签署此表格。
如果您有任何疑问，请与我们联系 240-393-5950
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