First Name *

Last Name *

Email *

Phone *

Age of Person(s) Seeking Services *

What state do you live in? *

Maryland
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For telehealth appointments, we must match you with a clinician licensed in your state. This does not apply for mental health coaching.

How Do You Want to Pay for Services? *

insurance
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How Did You Hear About Us? *

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Important Note Regarding Insurance *

I understand that Washington Psychological Wellness is in-network with Carefirst/Blue Cross Blue Shield (BCBS), Partners Direct Health and Cigna and out-of-network with most other insurers. If I am not using insurance, I agree to pay for therapy and may seek reimbursement from my insurance.

What type of services are you seeking? *

Adolescent & Teen Therapy

Adult Therapy

Child/Play Therapy

Couples Therapy

Family Therapy

Psychological Assessment

Telehealth

Therapy for Veterans

Mental Health Coaching

Other

I need help figuring out what is best for me or my family

You may select any or all options.

Reason for seeking treatment? *

Please provide and additional information you'd like us to have. *

When is the best time to reach you? *

What is your preference for sessions? *

In-person

Telehealth

Open to either

If you were referred to a specific clinician or have already reviewed our therapists’ bios, please tell us who are you interested in working with. *

Please review our clinicians and select who you'd like to work with. **Based on Clinician Availability**

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