Request an Appointment

We want to help you get an appointment that works

for you.

If you are making a routine, new patient or follow-up appointment, you can call us now, 301-636-6504.

If you are a new client or partnering agency that would like to refer a new client for mental health services, you may also use our referral form. Completed referral forms can be mailed, faxed, or hand delivered using the information found at the top of the form. Upon receipt of the completed referral form, we will contact you to schedule an appointment.

Please do not use this request form if you have an urgent request – call us at 301-636-6504.

If you are experiencing a mental health medical emergency, call 911 or go immediately to the closest emergency room.

QCI provides services for English speaking patients at this time. QCI will attempt to direct non-English speaking individuals to appropriate resources to the best of our ability.

NOTE: When using the email addresses below, your information is not encrypted. Your responses may be read by others using your Internet service. Please do not include any sensitive information.