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New Client Contact Form

Looking for Couples Counseling? Please complete our Couples Form!

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We will email you our intake paperwork and an invitation to our Simple Practice portal within two business days.

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If you do not receive our intake paperwork in that timeframe, please give us a call at 410-324-2216.

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "submit" you agree to hold Heart & Mind Counseling Services harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

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877-626-5330 Fax    

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