Request Appointment

Home Request Appointment

Full Name *

Date of Birth *

Gender *

Marital Status

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Email Address *

Phone Number *

Is this your first visit? *YesNo

Reason for Visit *

Psychiatric history (If any)

Allergies

Referrals

Our Contacts

14300 Cherry Lane Court, Suite 108, Laurel, MD 20707

1000 Smyrna Clayton Blvd, Suite 5, Smyrna, DE 19977

Call Us: +1-800-532-4513
Fax: 443-443-5055

Email Us
info@kairosembrace.com

Useful Links

https://www.samhsa.gov
https://health.maryland.gov/pages/home.aspx
https://www.poison.org
https://www.psychiatry.org/

For 24/7 emotional support, call or text the National Suicide Prevention Lifeline at 988

If you're having a medical or mental health emergency, call 911 or go to your local ER.

Facebook Twitter Instagram

Designed and Developed by Guscorp Inc.

#medify_button_67072419aa1f8 { color: rgba(255,255,255,1); }#medify_button_67072419aa1f8:hover { color: rgba(255,255,255,1); }#medify_button_67072419aa1f8 { border-color: rgba(255,158,33,1); background-color: rgba(255,158,33,1); }#medify_button_67072419aa1f8:hover { border-color: rgba(46,166,247,1); background-color: rgba(46,166,247,1); }#medify_button_67072419aa1f8 { border-radius: 5px; }