Heart to Hand is ready to help you reach your sexual health and wellness goal. We welcome you to come visit our office in Largo, Maryland. Here’s what you need to know.
Appointment or Walk-in
At your appointment
Payment and Insurance Information
Heart to Hand provides no-cost or low-cost services. The front desk receptionist will let you know if the service will be at no cost to you or low cost. If any payment is required, Heart to Hand accepts several.
- Aetna – including Coventry and Mail handlers Benefit Plan
- United Health Care
- Maryland Medicaid
- Debit/Credit Card
Patient Information Form
Prior to your visit, please review the attached forms.
Consent to Services Form
Required form that gives Heart to Hand permission to coordinate services on your behalf.
Authorization of Release and Exchange of Information
Required form that designates Heart to Hand can send and receive information on your behalf. A form is required for each designated organization.
Client Grievance Procedure
Required form that states you have read and understood the organizations grievance process
Notice of Privacy Practice
Document that explains how the organization uses the medical information we collect from you.
Privacy Practices Attestation
Required form that states you have read and understand the Notice of Privacy Practice.
No Insurance Statement
Form that attests that client does not have health insurance.
Zero Income Statement
Form that attests that client as no source of income.
Eligibility Continuation Form
Required form that must be completed every six months to remain eligible for services with Heart to Hand.
External Referral Form
Form used to make referrals to services housed within Heart to Hand.