Contact - Olive Branch Counseling Services

Name *

First

Last

Email *

Phone Number *

How should I contact you? *

Brief description of why you are seeking therapy (e.g. parenting concerns, child behavior, general anxiety or depression) *

Please indicate your preferred days/times for sessions *

Are you (or is the patient) a current resident of the state of Maryland? *

Please note that I am only licensed to work with individuals in Maryland at the time of service.

Are you currently insured by any of the following (and would utilize them as payment for treatment)?