top of page

Online Intake Form

The purpose of this intake form is to prepare for the initial Transition House consultation and save time during our initial  session. Please complete the form before the scheduled appointment either online or download here and return the form.

Preferred Method to Contact
Are you the Authorized Representative to Speak on Behalf of Client?
Yes
No

Power of Attorney:

Medical
Yes
No
Financial
Yes
No
Trustee
Yes
No
Authorized Representative
Yes
No
Guardian
Yes
No
I am responsible for paying House Calls $250 intake fee and future appointments.
Yes
No
I Consent to Receive Bill and Pay Online
Yes
No

Information About the Person Needing Assistance (Client)

How Does the Client Prefer to be Reached?
Best Day For Initial Consult

NOTE: If the client will be resistant, it is better to meet with you alone the first time to develop a plan for connecting with the client.

Check most comfortable meeting places:
Categories of Need:
I agree to all terms of this document.

Dislaimer:

While we are dedicated to providing compassionate support to individuals who are committed to their journey towards mental health and stability, Transition House is not a crisis center and is unable to engage with individuals directly out of jail or exhibiting violent or consistent criminal behavior. We encourage those in immediate crisis to contact their local crisis center for urgent assistance.


Please note that Transition House does not provide addiction treatment services. Our clients adhere to prescribed medication as directed by their healthcare providers. Compliance with medication is essential for consideration in our housing programs, ensuring a safe and supportive environment for all residents. For more information or assistance, please reach out to your local crisis center.

Privacy Policy

Subscribe to stay in touch

Thanks for submitting!

Curious about the state of mental health in Maryland according to NAMI? Click here.

© 2024 by Transition House LLC

bottom of page