Website Contact Form
We are so glad that you want to connect and get more information about our services. Whether you just have some questions or would like to get scheduled with one of our clinicians this form will allow us to help you best.

Please fill out to your best ability and we will be in touch shortly. If you do not hear back from us within 24-48 business hours please reach back out to us as we may not have received your request. Please remember you can always contact us at 410-841-9647.
Name of Individual seeking Counseling (First and Last)? *
If different from above, please tell us your name (First and Last)?
Preferred way to contact you (please note that email may not be a secure means) *
Good Contact number
Good Email
What is the best time to contact you between 8am and 4pm?
How can we assist you? *
If you are looking to schedule, please tell us your time preferences:
Which counselor(s) would you prefer?
If the counselor does not have availability, would you like to be added to the waitlist?
Service being requested
Please check all that may apply :
If you can provide a little information about why you are seeking counseling, this will help us determine the best match for you:
If you're interested in scheduling, please indicate below which insurance company you currently have. (Please note that our clinicians may not be in-network with your particular insurance plan. If you plan to use out-of-network insurance benefits, we will be happy to discuss your options with you.)
Please tell us how you heard about us
Would you like to be added to our Mailing list to receive updates?
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