Poa Sana Healthcare

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Consultation Details

Schedule & Consultation Request Form

Thank you for choosing Poa Sana Health Care Services & Consultants LLC. Please complete the form below to request services and schedule a consultation. A member of our care team will contact you within 24–48 hours to confirm your appointment.

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Consultation Details

Client Information

Full Name:

Date of Birth:

Phone Number:

Email Address:

City / State:

Services Requested

Mental Health Evaluation

Psychiatric Medication Management

Therapy / Counseling

Community Outreach Services

Residential Mental Health Support

Post-Hospital Discharge Follow-Up

Family Support Consultation

Case Management / Care Coordination

Reason for Consultation:(Please briefly describe the concern or service you are seeking).

Preferred Appointment Type

Telehealth
In-Person Visit
Home Visit
Community Location

Preferred Appointment Date:

Preferred Time

Morning
Afternoon
Evening

Preferred Contact Method

Phone
Email
Text Message

How Did You Hear About Us?

Website
Social Media
Healthcare Provider
Family / Friend
Community Program
Comment

Consent

By submitting this form, I consent to being contacted by Poa Sana Health Care Services & Consultants LLC regarding my consultation request and scheduling.

Agree as per the information provided

Yes
No

Address

Office

Maryland

📍 2 Post Office Road, Suite 4A Waldorf, 20602

Office

Washington DC Office ,

1212 Gallatin Street NW Washington, DC 20011

Contact

Phone: +202-827-6830
Email: info@poasanahealthcare.com

Opening Hours

Mon-Sat: 8M - 6PM
Sunday Closed