Helpful Patient Forms

Patient forms page update 06-29-2018

Hello. The decision to take better care of yourself with holistic psychotherapy and counseling is a step towards improving your mental health wellness.  You'll find a link to a private page for all forms, pdfs and apps needed for new and current patients.

Get the most from your visit

We recommend that you fill out the forms before coming.  If you're able, kindly return the completed paperwork before your visit. If you do, they can be reviewed in advance of your appointment. Please use the encrypted email address that was provided in your confirmation email to return forms.

Your initial appointment is 75 minutes. By filling out forms before coming, there's more time to discuss what brings you in. If you're unable to print out these patient forms, they can be mailed to you.  Just ask.

Patient forms to print & sign

Click here: forms, pdfs & apps private page. It's password protected. Please use password sent to you.

Reference documents

These reference documents provide additional information.  The docs pertain to the ethical practice of psychotherapy and counseling and your rights to privacy.  These docs do not need to be returned.  They're for your reference only.

Lucrezia Mangione, NCC, LCPC practices the art of care and clinical mental health counseling. Her practice is diverse, inclusive and respectful of people regardless of race, color, religion, gender, gender expression, age, national origin, disability, or sexual orientation. 

As a Board-certified licensed clinical professional counselor, Lucrezia Mangione, NCC, LCPC, follows codes of ethical conduct. They are outlined below through links to various websites of state or non-profit organizations where she is either licensed by, certified by or is a member of.  Links are also provided here that detail your rights as a client and patient with HIPAA.

What's HIPAA?  HIPAA describes how health care providers can use your private health information, how it can be shared, what safeguards need to be in place to protect that information, your rights of access to it, and the requirements we, as providers of health care, have to follow. You'll find this info at these links:

Free Phone Consult

It's important to work with a counselor who's a good fit for you. I offer a free 10-minute call to explore the best steps forward.  Schedule a call.

Emergency Numbers

If you are experiencing an emergency, please call:

  • 911
  • 240-777-4000: Crisis Hotline, Montgomery County, MD
  • 800-422-0009: Maryland state-wide Crisis Hotline
  • Suicide Prevention Lifeline website

For your information

Please be advised Lucrezia Mangione, LCPC, only provides counseling and psychotherapy services and clinical supervision under her license in Maryland as a Licensed Clinical Professional Counselor.  In a separate practice, Lucrezia Mangione offers her services as a Wellness Coach & Integrative Health Consultant.  If you are interested in her coaching and consulting services, please visit the separate section of this website that features those services. You'll find them under the navigation tab labelled "Wellness 3C's."

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Lucrezia Mangione is in private practice. She is a board certified licensed professional counselor, board certified telemental health provider, counselor supervisor and educator, and nurse wellness education consultant. View her profile.