The Growth Center Waiting List
Please complete the form below and we will reach out to you when we have an available appointment that meet  your needs. If you are in immediate need for therapy services, please contact the number on the back of your insurance card, call 211, or 911 if it is a true psychiatric emergency.
Sign in to Google to save your progress. Learn more
Email *
Your name *
Preferred Pronouns *
Phone number *
I'm looking for *
In a few words, what is bringing you to therapy at this time? *
I am interested in working with *
Availability Preference (please include all available days) *
Do you have insurance coverage, and if so who is your insurance carrier? *
If you don't have insurance coverage for mental health, what is your estimated annual household income? We use this as a starting place for determining your sliding scale rate. *
Were you referred for services by anyone? *
Are you a past client of The Growth Center? And if so, who was your therapist? *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Growth Center Baltimore. Report Abuse