Form Test Page Sibley Group Intake Form "*" indicates required fields Your Name* First Last Your Email* Patient's Name (if you are filling this out on someone's behalf) First Last Patient's Age*School and GradeBest Contact Phone Number*How did you hear about the practice?*What issues are going on?*At which office do you wish to schedule an appointment?*Chevy ChaseCapitol HillGeorgetownNo PreferenceDo you prefer in-person or virtual appointments?*In-PersonVirtualNo PreferenceWhat days are you available and what time of day works best?Do you have a preference as to the clinician's age/sex/gender/race/etc.?*Do you have a specific therapist you were referred to?Consent* I have read and understand The Sibley Group insurance and billing policy. Download financial forms here.I understand that The Sibley Group does not accept any insurance; all appointments are self-pay at the time of service; The Sibley Group provides a superbill at the end of each month, which can be used to submit to your insurance company. By request, TSG can explore reduced fee options.Additional information you'd like to share Δ
