contact us

Please complete the following information and someone will reach out to you from our office in 24-48hrs.

By providing a telephone number and submitting the form you are consenting to be contacted by phone/SMS text message from Silver Psychotherapy. Message frequency may vary. Message & data rates may apply. Reply STOP to opt-out of further messaging.
See our Privacy Policy .

Email(Required)

Phone Number(Required)

Patients Name(Required)

First Last

Patients Date of Birth(Required)

Month

Day

Year

If Patient is a minor, please list parent/guardians name.

First Last

If Patient is a minor, Parent or Guardian Phone number

How did you hear about us?(Required)

Friend/Family

Google Search

Psychology Today

Physician Referral

Other

How do you prefer to pay for your Services?(Required)

Blue Cross/Blue Shield

Cigna

United Healthcare/UBH

Self-Pay, I will pay for treatment

Other

What type of services are you seeking? (You may check multiple services)(Required)

Psychiatry/Medication Management

Child/Play Therapy

Individual Therapy

Parent/Caregiver Coaching

Are you interested in Virtual/Telehealth or In-Person treatment?(Required)

Virtual/Telehealth

In-Person, I would like to come into the office

Can you give us a brief description of why you are seeking treatment at this time?(Required)

CAPTCHA

5970 Frederick Crossing Lane, Suite 100
Frederick, MD 21704

Phone: 240-415-8893
Fax: 240-466-1993

Home
About Us
Services Offered
Patient Resources
Employment
Wellness Wherever
Blog