Contact Us

All Inquiring Clients Must Submit This Inquiry Form

Please note that we are out of network with all insurance companies. See our FAQs for more information about out-of-network reimbursement or single case agreements.

Name *

First

Last

Email *

May we add you to our email list?YesNo

Phone Number *

What Type of Therapy Services Are You Seeking? *

• Adult or Young Adult Individual Therapy
• Child or Teen Individual Therapy
• Family Therapy
• Parent Coaching
• Couples Counseling
• DBT Skills Group
• I need help figuring out what is best for me or my family

You may select any or all options.

Which DBT skills group are you interested in? *Please select the appropriate groupTweens (ages 11-13)Teens (ages 14-18)Adults (ages 22+)

Please list your age (and/or the age(s) of those seeking services): *

i.e., if you are interested in family therapy, please list ages of all family members involved.

Are parents/legal guardians separated or divorced? *

• Yes
• No
• N/A; unmarried, single parent

Please indicate your custody status: *

• Joint legal custody
• Sole legal custody
• Other (please describe in "additional information" box below)

In order to authorize mental health treatment for your child, Maryland law requires that you have either sole or joint custody of your child. Before scheduling an intake appointment with our office, you will be asked to provide a copy of the most recent custody decree that establishes custody rights of you and the other parent, or otherwise demonstrates that you have the right to authorize treatment for your child.

What is your child's level of willingness to engage in therapy? *

What, if any, safety risks are you concerned about? *

• Self-harm
• Suicidal Ideation
• Substance Use
• Running Away
• Physical Aggression
• Other (please describe in additional information box below)
• None

If you or you child are in imminent risk, please call 988 or go to your local crisis center.

What, if any, treatment have you already received? *

Please describe any current or recent services including outpatient therapy, psychiatry, IOP, PHP, or hospitalizations.

Please provide any additional infomation you'd like us to have. *

What are you hoping to achieve through therapy?

When is the best time to reach you? *

Preferred contact method: *Please selectEmail Phone callText messageNo preference

Note: If you prefer email, please add info@mccounselingcenter.com to your contacts and check your spam folder if you do not hear from us within 24 business hours. Also know that we may need to call you for more information if deemed necessary.

Do you have a preference of location for services? *

• Rockville Office
• Olney Office
• Telehealth

You may select any or all options. If you want first available, please select all.

What state do you live in? *MDDCVAPA

For telehealth appointments, we must match you with a clinician licensed in your state.

Submit

Contact Us Today To Start Therapy In Maryland

For questions about any of our services or therapists, please check out our resources online, or fill out an inquiry form above. We do our best to respond to messages within 48 business hours. Thank you for your patience.

According to the Federal No Surprises Act of 2022, you have a right to receive a Good Faith Estimate for how much your medical care will cost.

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