Maristan Appointment Request Form
Assalamu Alaykum,

Thank you for choosing the Maristan clinic for your mental health needs.

Please note that we currently have a waitlist, and appointment availability is limited. We will reach out as soon as a slot becomes available. If you would like to be added to the waitlist, please complete this form, and we will contact you once we can accommodate your request.

If you have any questions, feel free to reach out to our team. We appreciate your patience and understanding.

Please complete this form using your personal information. If you have any questions please email clinic@maristan.org

* Please note that in addition to telehealth sessions, Maristan also conducts in-person sessions by request.
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*Note: Due to state regulations, you may only submit a form for yourself or those whom you have legal guardianship over.
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