Therapy Inquiry Form

Please complete the below form and our staff will reach out to you soon. We look forward to meeting you!

IF YOU ARE IN CRISIS, PLEASE CONTACT ANNE ARUNDEL CRISIS RESPONSE AT 410-768-5522.

STAFF ONLY: Check option below ONLY if you are Turning Stone Staff...

No, I'm a Client

STAFF MEMBER

TSC Staff Name *

Request Came in via... *

Did client provide a phone #? *

Yes

How did you hear about us? *

Who may we thank for referring you?

This Inquiry is regarding..... *

Individual Therapy for Myself

Individual Therapy for My Child

Individual Therapy for Another Adult

Relationship / Marriage Counseling

Family Counseling

General Question

Other

Contact Info:

YOUR full name, Phone # & Relation to client *

Parent/Guardian First Name: *

Parent/Guardian Last Name *

Parent/Guardian Phone #: *

Parent/Guardian Parent Email:

CLIENT's First Name *

CLIENT's Last Name *

Phone

What is your preferred contact method for discussing scheduling? *

Phone (Ok to leave a voice message)

Phone (DO NOT leave a voicemail)

Primary Insurance Provider

Please tell us how we can help, or list any questions you have below.

Would you be interested in any of the following communications from Turning Stone Counseling?

Waiting List Update Emails

Referrals to Other Local Counseling Centers

TSC Monthly Newsletter

Future Webinars / Workshops

Group Therapy Offerings

(Select all that apply)

Click ‘Submit’ below….

Please allow 24-48 business hours for response.