New Client Inquiry Form
WAITLIST TEMPORARILY CLOSED: Due to being on medical leave for post-surgery recovery, Dr. Danielle Gill is temporarily not adding any new families to the waitlist and will not be calling for phone consultations at this time. As of 1/27/2025, it is estimated that the waitlist will re-open in early to late April 2025. Please check back for updates!
If this is an *emergency* please call 911 or 988, go to your nearest hospital emergency department, or if it applies to your location you can also call the Maryland Youth Crisis Hotline open 24/7/365 at 1-800-422-0009 or the Anne Arundel County Crisis Line at 410-768-5522.

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Your Full Name (First and Last) *
Your Relationship to Child: *
Phone Number (XXX-XXX-XXXX format) *
Email Address *
Child's Full Name (First and Last) *
Age of Child (in years) *
Birthdate of Child *
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How can we help? Please provide a brief description of what you are seeking services for. *
Who referred you or how did you find out about Anchored Behavior Therapy? (e.g., pediatrician Dr. Smith, a family friend, Facebook, Google search, PCIT website, Psychology Today, etc.) *
By clicking “Yes, I acknowledge" and submitting this form, you acknowledge that the information you provide in the form will be sent to Anchored Behavior Therapy electronically. Although we use a secure HIPAA-compliant system, please do not include sensitive information that you would like to keep confidential. Please note that submitting this form does not create a formal therapeutic relationship. The therapeutic relationship begins when a psychologist has completed a diagnostic evaluation at the intake session, determined your child is a good fit for treatment with them, and engaged in follow-up appointments. *** If this is an emergency, please call 911, 988, or go to your nearest hospital emergency department. *** *
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