Counseling Services

Individual
Couples & Family
Relationship Issues
Grief and Loss
Anxiety and Fears
Depression
Personal Growth
Parenting Support
Stress Management
Family
Woman Blowing on Flower

Make an Appointment

 


How to make a referral: Please contact our office secretary and you will be prompted to complete an initial screening intake. This form includes reported demographic information and presenting problems. You can also print out the attached intake form and send to our office to begin the referral process. Once this information is obtained, insurance verification will occur and authorization will be requested from your insurance company. The secretary will promptly contact you to schedule an intake appointment with one of our licensed therapists in the office.
 
Please bring the following documents to your initial appointment:
  • Birth Certificate
  • Social Security Card
  • Medical Insurance Card
  • Copy of recent physical examination
  • Copy of immunization records
 
**These documents are required per the State of Maryland Department of Mental Health and Hygiene requirements**

 

 

If you are interested in services, please contact the intake coordinator at the Wicomico or Somerset offices.

 

Irene Thomas  at Wicomico County Clinic 410-677-0202
Renee Carlins at Somerset Clinic 410-968-3547 

OMHC

Respite

PRP

MHVP 

MHVP Referral Form 2017

https://docs.google.com/a/maple-shade.org/forms/d/1xzTivowLdgCprnrtwm6WC5S4NwQizSxKtXBCET5obQ8/edit

 

 

Discounted Fee Scale
 
Maple Shade Youth and Family Services use a discounted/sliding fee schedule to ensure that non one who is unable to pay will be denied access to services. 
Please see the front office staff for an application and the requirements for this program. 

 

Note: To download Adobe Acrobat Reader for free,click here

 

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

Please don't put anything here:
Please enter the words below: Click to reload image What is this?


By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.

Helpful Forms

Click here to view and print forms for your appointment.

CLICK HERE