Complete each of the 8 forms and print separately prior to the appointment.

1. Family Program Screening Document

2. Infectious Disease Screening Document

3. Patient and Staff Agreement Document

4. HIPPA Private Practice Document

5. Spirituality Assessment Document

6. Health Questionnaire Document
 
7. Gambling Questionnaire Document

8. Nicotine Use Questionnaire Document
 
Documents must be printed out to be returned to the Frederick County Health Department.

* 1-800-Quit-Now Document
 
* 1-800-Quit-Now Poster Link

* Market Street Adolescent Activities Center