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Request a Couples Appointment 

We're glad that you have chosen Kin-Etic Behavioral Health for your and your partner's mental health journey! Please complete this form to help us get to know you better. 

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Before completing the form below, please note the following:

  • We do not accept appointments through Employment Assistance Program (EAP).

  • All appointments are held virtually (via video or phone) until further notice.

  • If you are seeking services and your deductible has not been met, you will be charged your insurer's contracted rate.

  • If you are seeking services out-of-pocket, pleases click here to view our fees.​

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Once your information is received, our office will contact you within 1-2 business days to schedule an appointment.

Please provide your information in this form.

Date of Birth
Month
Day
Year
Are you seeking services through insurance?
Yes
No
If yes, please provide your primary insurance provider. We highly recommend that all clients familiarize themselves with their insurance plan before making an appointment.
Are you a Maryland or DC resident?
Yes
No
Are you interested in other service(s)? Please check all that apply.
How did you hear about us?
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