Services Request Form

Rockville Therapy Center LLC offers practical, personalized, and collaborative care for individuals ages 3+ who are coping with Selective Mutism, Teen Social Anxiety, and Tics/Tourette's.

Please correct the errors described below.

Thank you for your interest in services at the Rockville Therapy Center LLC!

To request services, please provide complete information in this form to build your profile in our system. We currently serves individuals and families coping with Selective Mutism, Teen Social Anxiety, and Tics/Tourette's. Referrals will be provided for all other areas. Appointments are held in person (M/W) and virtually (M/W/Thu), during the hours of 9am to 5pm (4pm is the latest appointment time).

Once you submit this form, it will be reviewed within 1 week. At that time, you will be contacted by email to either: a) schedule a brief (15-minute) no-cost initial phone screen, or b) we will provide you with 2-3 referral options of other providers and practices whose specialities might better serve you and/or your family's needs.

After a completed phone screen, and when there is an appropriate fit, you will be added to the waitlist for services. When an opening becomes available, you will be contacted by email to complete the Intake and Consent Forms and Schedule an Initial Evaluation appointment. For child services, both/all parents/legal guardians must complete all Forms.

Unfortunately, we are unable to provide a time estimate but want to assure you that you will be contacted. If you have any questions, or would like to check on the status of your request, contact us:

For selective mutism camp services, please email us

For individual or group therapy services, please email us

Email is our fastest means of communication, though you are welcome to call us at (301) 245-6260 to leave a detailed message.

Thank you, and take good care!

Rockville Therapy Center LLC

For Parents seeking services for a CHILD (under age 18):

(skip to the next section if you are an adult seeking services for yourself)

write NA if not applicable
write NA if not applicable

For ADULTS seeking services:

write NA if not applicable
write NA if not applicable

What To Expect After Submitting Your Service Request Form:

For non-wait-listed services, we should contact you with-in 2-5 business days. After this period, you may also follow-up with Dr. Scharfstein at, or for camp inquiries, The practice phone number (301) 245-6260. We, unfortunately, are unable to provide status updates and/or projections for wait-listed services. In the meantime, please learn more about the practice at With appreciation and gratitude!

Thank you from Rockville Therapy Center LLC!

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