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Maristan Appointment Request Form
Assalamu Alaykum,

Thank you for choosing the Maristan clinic for your mental health needs. Submitting this form does not guarantee immediate scheduling. Our team will contact you to complete a pre-screening call. Please complete this form for yourself or your legal dependant. 

If you have any questions please email clinic@maristan.org

* Please note that in addition to telehealth sessions, Maristan also conducts in-person sessions by request.
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Who are you seeking services for? *
*Note: Due to state regulations, you may only submit a form for yourself or those whom you have legal guardianship over.
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