Apply for Services

If you have any questions not answered elsewhere on the website regarding our Vocational, Foundations, or Supported Living programs, please call 301-493-4200 x22234 and leave a message. If you have questions for the Clinic please call that location directly. Please note that there may be a waiting list for these programs.

To apply for our Clinic, Vocational, Foundations, or Supported Living programs please complete the following:


Universal Program Application


To apply for Assertive Community Treatment (ACT) services, complete the ACT Referral.  Referrals should be faxed to  888-525-4231.

ACT Referral

To apply for Residential Crisis Services, complete the RCS Referral.  Referrals can be faxed to 844-762-3230 or emailed to 


RCS Referral


To apply for Residential Rehabilitation Program (RRP) services, complete the Local Behavioral Health Authority’s (LBHA) Application, and return to to:

Montgomery County LBHA

401 Hungerford Dr.

Rockville, MD 20850

FAX - 240-777-1145


LBHA RRP Application