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Intake forms
Please download and complete one of the packets below and either email it to drpamluttig@gmail.com or mail it to 8222 Lilly Stone Drive, Bethesda, MD 20817 before your first appointment.
Please read each section carefully and sign where indicated. Feel free to contact me if you have questions or concerns. Complete only one packet based on the primary patient's information.
Child & Adolescent Patient Intake Packet
To be completed by parent[s]. The Informed Consent Agreement must be signed by both parents or legal guardians.
Adult Patient Intake Packet
To be completed by adult patient (18 years +)
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