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Our Services
Telepsychiatry
Spravato Treatment Center
Contact Us
- Patient Forms

Call: 703-865-8686

Call Today: 703-865-8686

Home
About Us
Our Clinicians
Our Services
Telepsychiatry
Spravato Treatment Center
Contact Us
- Patient Forms

Fill out the form below for new inquiries only, our existing patients should call office or contact us through our patient portal.

Your Name*

Your Email*

Your Phone Number*

Your Message

Patient Forms

Our Patient Forms are available to fill out online and submit electronically.

Click on the form below that you need to complete.

1. Acute Concussion Evaluation Scale

2. Adult ADHD Self-Report Scale Symptom Checklist (ASRS-v1.1)

3. Assignment of Benefits

4. Confidential Exchange of Healthcare Information Form

5. Consent for Diagnosis and Treatment

6. Controlled Medication Prescriptions Agreement

7. Eating Questionnaire

8. Epworth Sleepiness Scale

9. Group Counseling Informed Consent

10. Medical Release Form

11. Medical Records Request

12. New Patient Registrations Forms - Adult

13. New Patient Registration Forms - Minor

14. Notice of Privacy Practices

15. Office Policies

16. Patient Record of Disclosures

17. Pittsburgh Sleep Quality Index(PSQI)

18. Post-Concussion Scale—Rivermead

19. Referral for Psychiatric Services

20. Screening for BPD

21. Symptom Checklist Before Seeing Counselor

22. Telepsychiatry Informed Consent

For me, it has taken more than a year of Spravato treatment to fill some difference. Now, 14 months later, I am finally slightly more energetic and feeling more relief of depression and darkness.

When I came to NeuroPsych Wellness, I was experiencing the breakup of a long-term relationship and was feeling lost. After just one session with Craig, I had a plan for going forward and ways to cope with my feelings. I look forward to each appointment and enjoy the smiling staff at the desk who are so kind. I now have my confidence back!

I am grateful to be able to relieve Spravato treatment. It is something that has finally helped my depression like nothing else ever had. After 30+ years, I finally feel a lot better.

I am extremely happy with the service and people. It’s such a positive & helpful experience. I would highly recommend it for anyone considering.

For me, it has taken more than a year of Spravato treatment to fill some difference. Now, 14 months later, I am finally slightly more energetic and feeling more relief of depression and darkness.

NeuroPsych Wellness center is focused on effective and compassionate care. Doctors as well as other staff/employees are helpful, genuine and, interested in patients. Highly recommend this practice.

Subtle but definitely help to my depression.

Spravato has helped me immensely.

Neuropsych Wellness Center Patient Testimonials

NeuroPsych Wellness Center | 3930 Pender Drive, Suite 350, Fairfax, VA 22030 | Phone: 703-865-8686 | Fax: 703-865-6506

Serving: Fairfax, Tysons, Springfield, Chantilly, Manassas, Alexandria, Washington DC

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