Patient Forms

Thank you for choosing Riverside Counseling Center.

For Online Documents: Click Complete Online

For PDF Documents: Download the pdf version of the form and complete yourself, scan, and submit to frontdesk@riversidecounseling.net
Or fax to: (703) 724-4093

Please only submit paperwork once you have an appointment. Thanks!

Are You A New Patient?

We have bundled all necessary New Patient paperwork below. Complete online, or download a PDF to email.

ADULT New Patient Paperwork
Complete Online
Or Download PDF

MINOR New Patient Paperwork
Complete Online
Or Download PDF

Other Helpful Forms

Telehealth Consent Form   Complete Online / PDF
Release of Information   Complete Online / PDF
Missed Appointment Appeal Form Complete Online  / PDF
Medicare Opt Out Form Complete Online  / PDF

Misc. Doc Attachment Portal Upload Here

For PDFs, please download, complete and email to frontdesk@riversidecounseling.net