Congruent Counseling Services

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When filling out the form, please do not put any private, medical information on this form as it is not encrypted. In case of emergency go to your nearest emergency room or call 911.

Name
This field is for validation purposes and should be left unchanged.
Where would you see the clinician in person?*
If/when that is possible to do again.
Are you interested in:
- Learning more about CCS
- Scheduling an appointment
- Doing an assessment
- Other
How May We Help?*
Name*
First Last
Email*
What's your phone number?*
Disclaimer*
- I agree to receive communications by text/SMS about my inquiry. Terms & Conditions: By clicking the box you agree to subscribe to Congruent Counseling Services (CCS) text/SMS services and to receive text messages from CCS. CCS will send text/SMS messages to communicate with you on the status of sessions or information requested to provide a better overall experience. For HELP, please contact us at +1 410 740 8066, or email [email protected]. To opt-out of receiving messages, reply with “STOP” at any time. Message frequency may vary. Standard message and data rates may apply. You may review our Privacy Policy to learn more about how your data is used. No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.
Have you cleared your voicemail to be able to receive our message to you?
- Yes
- No
Address*
City ZIP / Postal Code
Do you have a particular clinician in mind?
- Yes
- No
Which clinician would you like to see?
What is your insurance, if you're using it? If none, say "none"*
Be aware, your mental health coverage might not be the same organization as your health insurance!
What days and times are best for you?
We will accommodate this if possible, but please understand that it may not be.

Have Questions?

We try to respond within 24 hours

Contact Us

Contact Form