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Tides of Change Wellness

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Please share reason for seeking treatment

IInsurance Provider

Has the patient experienced any of these events within the last 6 months? * Required

Suicidal ideation

Internalized behaviors of self harm

Externalized behaviors of self harm

Hospitalization

School refusal

Restrictive eating

Perfectionism

Rigid thinking

Difficulty connecting with others

None of these

Do you prefer in person or virtual appointments? Are you located in Maryland or Virginia?

Do you have a day/time preference?

Thanks for submitting!

This form will be sent via HIPAA compliant e-mail, and our administrative staff will reply in a timely manner. If you do not hear back after four business days, please check your Spam folder before reaching out again.

New Patients

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Insurance Questions

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If you don't recieve a response from us in 3 business days, or if you cannot find your portal invite, please check your Spam folder.

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