Welcome to

Patient Forms

Please Read First

Before your first visit, please complete all the forms below.

Start with the Cover Page for instructions.
Download and fill out each form.
Bring the completed forms with you to your appointment.

Forms to Download

01

Cover – Instructions for Patients

02

Authorization to Bill Insurance

03

GAD-7

04

Informed Consent for Treatment & Assessment

05

Notice of Privacy Practices

06

The Patient Health Questionnaire (PHQ-9)

07

Records Release Authorization

08

Telehealth Services Informed Consent

Need Help?

If you have any trouble downloading or filling out these forms, please call our office and we’ll be glad to assist you.

Phone Number

+1-800-532-4513

Fax

443-443-5055

Email Address

info@kairosembrace.com

Ready to begin your mental health healing journey?

Whether you’re facing anxiety, depression, or overwhelming stress—help is here. Let’s walk this path to healing together.

A healing place where mind, body, and spirit are cared for through psychiatric care, therapy, and faith support designed just for you.

Quick Links

Contact

+1-800-532-4513

443-443-5055

info@kairosembrace.com

Follow us on social

Services Area

14300 Cherry Lane Court, Suite 108, Laurel, MD 20707

1000 Smyrna Clayton Blvd, Suite 5, Smyrna, DE 19977

487 South Queens Street, Dover, DE 19904

Copyright © 2025 Kairos Embrace. All rights reserved

Privacy Policy | Terms & Conditions

Website by Zoob Media