Let’s work together

To start the intake process, please fill out the form below.
Someone from our Administrative Team will get back to you within 2 business days with available appointments.

This form is for new clients only. If you are an existing client that would like to make an appointment, please reach out to our administrative staff by phone at #301-793-3997 or email at admin@radianttherapycounseling.com

Radiant Therapy, LLC is in network with Blue Cross/ Blue Shield, Cigna and United Healthcare. *At this time we are NOT accepting new patients with Aetna, Medicaid, EAP, or Tricare insurance.

PLEASE READ FAQ'S BEFORE FILLING OUT FORM BELOW

CLIENT INFORMATION

Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

If Client is under the age of 18

Please put your name and relationship to Client below

Email

Phone

(###)

###

####

Preferred form of contact

CLINICAL INFORMATION

Reason for therapy

Please do not include confidential or sensitive information.

Preferred Availability

We only see clients during our hours of operation. Mon - Thur 10am - 8pm, Fri 10am - 4pm, Sat 10am - 2pm. Closed on Sundays

In person or Telehealth appointments

If you are looking for telehealth services, clients must be in Maryland at the time of service

Preferred Therapist

Insurance Carrier

Let’s work together

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