Services Request Form

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

Please correct the errors described below.

Thanks your interest in services at Rockville Therapy Center LLC!

To request services, please complete this form to build your profile in our system. We currently serve individuals and families coping with Selective Mutism, Social Anxiety, Anxiety, and Tics/Tourette's, and will provide referrals for all other areas.

Appointments are in-person on Mondays and Wednesdays, and virtual on Thursdays, from 9 am to 5 pm (new client openings are often before 3 pm).
We do not accept insurance. Clients pay upfront and receive a monthly Superbill on the 1st of each month via our Client Portal that details all services, codes, diagnoses, dates, and costs.
Child Services: All parent/legal guardian contact information must be included in this form.

Once you submit this form, it will be reviewed within 1 week. You will be contacted via email to either: a) schedule a brief 15-minute no-cost initial phone screen, or b) receive 2-3 referral options to other providers whose specialties might better serve you and/or your family's needs.

After the phone screen, if there is an appropriate fit, you will be added to the waitlist for services. When an opening becomes available, you will receive an email to complete the Intake and Consent Forms and schedule the Initial Evaluation appointments. For child services, all parents/legal guardians must complete all forms.

We cannot provide a time estimate but assure you that you will be contacted.

For questions or to check on the status of your request, contact us! New Clients: info@therapyrockville.com and SM Camp Clients at camp@therapyrockville.com

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 info@therapyrockville.com, or for camp inquiries, camp@therapyrockville.com. 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 https://therapyrockville.com/. With appreciation and gratitude!

Thank you from Rockville Therapy Center LLC!

Your information will be encrypted.

Loading...