Welcome!

I look forward to collaborating with you to improve your health and ultimately thrive in life.
To discuss and schedule your first consultation appointment please call (240) 753-0095 or

Request Consulatation

Schedule Appointment

Request to schedule appointment

Name*
First Last
Email*
Phone Number*
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Message
How did you hear about us?
- Mental Health Provider (Psychiatrist, Therapist)
- General Provider (Primary Care, OB/Gyn, Nurse)
- Family or Friend
- Psychology Today
- Google Search
- Other (please specify in space below)
Acknowledgement*
I understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form.
- I agree

New Patients

Please click on the link below to download and print the Registration Forms.
Please complete the registration forms prior to your first appointment and bring them with you.
If you have any questions about any of the forms, please contact Mental Wellness Clinic.

Registration Forms and Policies

Mental Wellness Clinic

11404 Old Georgetown Rd, Suite 203
Rockville, MD 20852

(240) 753-0095

[email protected]

Fax Number: (973) 695-3653

Welcome!

Request Consulatation

Schedule Appointment

New Patients

Address

Phone Number

Email Address

Fax Number

Mental Wellness Clinic

11404 Old Georgetown Rd, Suite 203 Rockville, MD 20852

(240) 753-0095

[email protected]

Fax Number: (973) 695-3653

Welcome!

Request Consulatation

Schedule Appointment

New Patients

Address

Phone Number

Email Address

Fax Number

11404 Old Georgetown Rd, Suite 203
Rockville, MD 20852