Contact Us

All Inquiring Clients Must Submit This Inquiry Form

Insurance & Payment Information: We are out of network with all insurance plans.
You can check your out-of-network benefits using our secure Thrizer benefits tool here. For a detailed overview of how payments and out-of-network reimbursement work in our practice, please visit our Financial Information page.

Trusted by hundreds of families throughout Maryland DC and Virginia.

Please enable JavaScript in your browser to complete this form.

Your Name *

First

Last

Please enter your name here. If you’re a parent or caregiver, we’ll ask for your child’s information separately.

Email *

Phone Number *

How did you hear about our practice? *

What type of therapy services are you seeking? *

• Individual Therapy
• Couples Therapy
• Family Therapy or Parent Coaching
• Groups
• Mental Wellness Check
• I need help figuring out what is best for me or my family

You may select any or all options.

Who will be receiving services? *

Please provide the full name of the person seeking services. If it’s you, enter “myself.” If more than one person will be participating, please list each person’s name.

Please provide the age(s) of those receiving services. *

Please list the age of each person identified above.

Email address(es) for additional participants: *

Please provide an email address for each additional adult who will be participating in services.

Are the members of your family aware that you're seeking support? *

• Yes
• No
• It’s complicated (please describe in additional information box below)

Please select the group you are interested in: *

• RO-DBT Skills Class
• DBT Skills Group
• Family Recovery Support Group

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

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

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

Tell us a little about what brings you to therapy and what you're hoping to work on. *

Please include any current or recent mental health treatment, as well as anything else that would be helpful for us to know.

If you were referred to a specific clinician or have already reviewed our therapists’ bios, who are you interested in working with?

Specific Clinician Name

Important Note: We Do Not Accept Health Insurance *

• I understand that Montgomery County Counseling Center is Out-of-Network and does not accept insurance directly. I agree that I will be responsible for paying for my therapy, and then submit my Out-of Network reimbursement claims through my insurance company.

If you have questions about fees, insurance, or reimbursement, please review our Financial Information page for detailed guidance.

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.

Email  |  Phone  |  Instagram