Register with us through our Intake Form

*The Intake Form Will Greatly Assist Us to Provide More Information

To register with us, please fill out one of the INTAKE FORMS below. They are the same, but there 2 options (online & submit, or download the pdf file & print to use pen and paper). Use the method most convenient to you.

*If you would rather complete the intake form on the phone with one of our team members, you have the option to be interviewed (over the phone). However, a fee may be incurred depending on the length of the interview session.
Please note - We do not take insurance (we are private pay).

  • House Calls Total Wellness is committed to providing safe health standards and complies with state regulations.
  • House Calls Total Wellness continues to expand online coaching, counseling, & family therapy appointments nationwide.
  • If you are local to us in or near Montgomery County, Maryland, we are also meeting clients inside or outside the home to maintain a 6 ft physical distance.


Intake Form Option to Fill out Online and Submit


Intake Form Option to Download Pdf form to Print


Terms of Agreement Option to Download Pdf form to Print


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