New Client Contact Form
Gender

Thanks for submitting! We will contact you soon.

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "submit" you agree to hold Heart & Mind Counseling Services harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Thanks for submitting!

©2020 by Heart & Mind Counseling Services. Proudly created with Wix.com

Contact

Email 

Follow

Contact

410-324-2216 Phone

877-626-5330 Fax    

Email 

Follow

  • Facebook
  • LinkedIn
  • Instagram