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To get started, please fill out the contact form below and we will get back to you as soon as possible.

Name of client:

First Name

Last Name

Name of person completing this form:

First Name

Last Name

Relation to client:

Email:

Phone:

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Please provide a brief description of what you would like to address in therapy:

Location preference?

Garland office

Oak Lawn office

Online appointment

Open to all

Do you have insurance you would like to use?

Yes

No

If we do not accept your type of insurance, would you be interested in services with a student or post grad associate since they have reduced fees?

Yes

No

Do you have any preferences for your therapist (age, gender, specialty, etc.)? Or is there a counselor seen here on our website you would like to work with?