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Life threatening emergencies call 911. For YSS urgent matters call 301-202-1287.

Your Safe Space

Signed in as:

filler@godaddy.com

  • Home
  • Group Gallery
  • Events
  • Professional Referral
  • JOBS!!! Join Our Team
  • Today's WAIT LIST
  • Appointments
  • Payments
  • About
  • Meet
  • The TEAM!
  • Service
  • Supervision & Training
  • FAQ
  • FORMS
  • Resources
  • Whats new
  • Physical Address/Virtual

Account

  • Bookings
  • My Account

  • Sign out

  • Sign In
  • Bookings
  • My Account

Consent form for service to be completed before appointment

Download, complete, and email or bring these forms with you

Client Demographic Form (pdf)Download
Standard Intake (pdf)Download
Records Release Authorization (pdf)Download
Credit Card Auth (pdf)Download
Telehealth Emergency Contact Release (pdf)Download

Downloads & Self Inventory Assessments

Use the forms below to create plans and self checks when you're not feeling your best as well as when you notice changes within.   

My Safety Plan (pdf)

Download

Stress Inventory (pdf)

Download

PHQ-A for Adoloescents (pdf)

Download

Adult PATIENT HEALTH QUESTIONNAIRE-9 (PHQ-9) (pdf)

Download

Your Safe Space, LLC

10111 Martin Luther King Jr Highway, Suite 103, Bowie, Maryland 20720, United States

(301) 459-0708 - 301-327-1290

Copyright © 2024 Your Safe Space - All Rights Reserved.

YourSafeSpace.org

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