New Clients | The Art Room, Center for Creative Healing

New Client Intake Form

To start the intake process, please fill out the form below. We will get back to you within 3 business days with available appointments. Please be sure to check your junk or spam folder for our response.

Virtual therapy clients must be located in Maryland at the time of service.

Prospective Client Name (First, Last)

Your Name (if different from prospective client)

Preferred Pronouns

Date of birth

Phone

Address

What led you to consider therapy now?

What therapy services are you seeking?

Individual

Group

Who are you interested in working with?

Claire Kalala, LCPC, LCPAT

Lauren Parks, LCPC, LCPAT

No preference

How did you hear about The Art Room?

By checking this box, I confirm that I have reviewed and agree to The Art Room's Informed Consent and Practice Policies

Please check your spam or junk mail folder to make sure you don't miss any emails

Thanks for submitting!

**Virtual therapy clients must be located in Maryland at the time of service.**

Virtual therapy clients must be located in Maryland at the time of service.