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Therapy Interest Form
Thank you for expressing interest in scheduling an appointment with Akoma Counseling Concepts.  Please complete the information below to be scheduled with an appointment with a Licensed Clinician and Graduate Student Intern on our clinical team.  Please allow at least 72 hours for a member of our team to contact you.
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Email *
Name: *
Email address *
Phone *
State of Residence (We only see clients in Maryland and DC) *
How soon are you looking to schedule your appointment?
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The issue(s) I am seeking to treat in therapy (in 4 sentences or less): *
Have you been to individual therapy before?
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