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Get Started with Maryland Wellness

Taking the first step toward mental wellness is easier than ever with Maryland Wellness. Our streamlined referral and intake process ensures that you receive the support you need as soon as possible. Whether you’re a potential client or a referring provider, this page outlines everything you need to know to get started with our services.

Referral Process

At Maryland Wellness, the journey begins with our simple referral form, designed to help us understand your unique needs and connect you with the appropriate services. This form serves as both our referral and intake form, streamlining the process for clients and providers alike.

How It Works:

  1. Complete the Referral Form: Fill out the form below with basic information about yourself (or the client, if you’re a provider), including mental health needs and preferred services.
  2. Review and Assessment: Our intake team will review the form and determine the best fit for services based on the information provided.
  3. Schedule Initial Appointment: A Maryland Wellness team member will contact you to discuss next steps and schedule an initial appointment with one of our providers.

This process allows us to match clients with the right program and ensure timely access to care.

Intake Form

Our referral form doubles as the intake form, making it the first step for all new clients and referrals. By completing this form, you provide our team with essential details that help us assess your needs and align you with the most appropriate services.

Please complete the referral form below to get started with Maryland Wellness.

Referral Form
Are you completing this form for yourself or another person?

Client Information

Homeless
Preferred Method of Service
Preferred contact method (By submitting this contact form you consent to being contacted, which includes our company information.)
Please Note: We ask for insurance purposes
Pronouns (Select all that apply)
Race/Ethnicity (Select all that apply)
Please note that we ask this question to assure quality care for all.
Are you a licensed clinician and able to provide a qualifying diagnosis?

Expanded Client Information

Medicaid
Why are you referring your client to Maryland Wellness? (Select all that apply)
Is the client an adult or minor (under 18)?
Please check all qualifying diagnoses (select all that apply)
If psychosis noted as DX:

Have peer supports and other informal supports such as family been tried?
Has targeted case management been tried?
Has group therapy been tried?
Is the participant on medication?

Medication List

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Minor Client Information

Providers must answer 2 of the first 3 Functional Criteria questions. Questions 4 and 5 are required.
e.g. the minor cannot be maintained in a classroom setting due to anger outbursts, frustration, and verbal and/or physical aggression towards teachers and/or peers
e.g. the minor engages in self-harm behavior such as cutting and has acted aggressively towards family members as well as destructive in home environment
3. Significant psychological or social impairments causing serious problems with peer relationships and/or family members?
e.g. the minor avoids social interactions and cancels plans frequently with peers and family due to anxiety caused when around others; minor is frequetly isolated which worsens distress. Frequent tantrumming has made it difficult for family members to discipline and assist minor with better choices.
e.g. minor continues to make reckless and impulsive decisions at school and in the community which have negative impact on minor, such as school suspensions, and problems with authority figures despite participation in therapy. Minor could benefit from more time and more direct assistance.
5. Has the youth made progress toward age appropriate development, more individual functioning and independent living skills?
e.g. minor is making some progress; with consistent prompting when situations allow, minor has been able to better manage anger, and self calm and decrease explosive behavioral outbursts however this is not yet consistent.

Adult Client Information

Providers must select a minimum of 3 out of the 7 following questions.
e.g. Client suffers from bipolar II disorder with extreme emotional fluctuation which causes conflict within the workplace.
e.g. Client has major depression (recurrent) and lacks motivation and avoids completing basic tasks such as laundry, housekeeping, meal preparation.
e.g. Client has borderline personality disorder and can be volatile around personal support system which they push away.
e.g. Client contends with bipolar I disorder. Mania episodes lead to anger outbursts and getting frustrated easily which results in them them failing to complete tasks.
e.g. Client’s major depression causes them to feel unmotivated, leading to trouble completing basic hygiene like dental hygiene, showering, changing of clothes.
e.g. Client’s bipolar and frequent mood fluctuations that make it difficult to start and finish tasks, recall and follow multi-step directions and because of frustration, often give up on tasks.
e.g. Client has schizoaffective disorder leading to disorganized thinking and behavior, which limits access to resources particularly financial support as they often have trouble understanding forms and rules related to the assistance requested.

Your Information

Please include your full name, credentials (e.g., LCSW-C, MD, RN), and the date in the signature box for the referral to be processed successfully.

Maximum file size: 52.43MB

Maximum file size: 52.43MB

Maximum file size: 52.43MB

Maximum file size: 52.43MB

Maximum file size: 52.43MB

Maximum file size: 52.43MB

Maximum file size: 52.43MB

Maximum file size: 52.43MB

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Insurance and Payment Information

Maryland Wellness is committed to making quality mental health care accessible to everyone. We accept a range of insurance plans and offer flexible payment options to ensure clients can receive the care they need.

  • Accepted Insurance: We currently accept Maryland Medicaid, Maryland Medicare, and most major commercial insurance plans, including Blue Cross Blue Shield, Aetna, UnitedHealthcare, and Cigna. For questions about specific insurance plans, please contact us at 410-314-1030 ext. 3 or consult your insurance provider.
  • Self-Pay Options: For clients without insurance, we offer a sliding fee scale based on income and family size, ensuring affordable access to care. Our self-pay options cover all services, including therapy, psychiatric evaluations, and medication management.
  • Payment Methods: Payments can be made by check, credit card, or through our client portal for secure online transactions.

Insurance and payment information is subject to change. Please contact us or consult our billing department for the most current information.

“When I first started, I was afraid to talk but once they started telling me about this program, I started to open up more. They taught me that I am important; it’s about me today. They have taught me to forget about the past and focus on my goals – my GED,  nursing, helping the homeless, volunteering, etc. This is the most amazing, awesome program in Baltimore, and that’s from my heart. The staff is wonderful, amazing, beautiful, unique and have hearts of gold.”
– K.S., Baltimore
“I absolutely felt 100% at ease talking. I’m so happy that I’ve found this place.”
– Anonymous
“It is a very good program, and the staff are nice and very helpful… they have helped me branch out of my comfort zone. They are always there when I need help or even just a quick check in. Thanks for helping me find my true self and helping me along my journey.”
– X.F., Baltimore
“I have received positive feedback from clients that have been referred to your organization.”
– Partner

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