Please complete and submit the following form for consideration for counseling. Your responses will be reviewed and you will be contacted within 48 hours (excluding weekends and holidays) , if applicable to discuss your counseling needs. During this brief consultation, you will have an opportunity to ask questions about working with me or the counseling process.

Submitting this form is not an agreement to receive counseling services; however, it is the first step in the process. If applicable, the next steps may include a brief phone discussion about your counseling needs and scheduling your first session or being placed on the waiting list.

Also, be sure to review

https://www.mhawellness.com/ for more information on counseling services provided, insurances accepted, self-pay rates and hours of operation (Tuesday-Thursday 9am-3pm and Fridays 8am -12pm CST), etc.

Please read before completing this form: 

*You are NOT a candidate for tele-mental health counseling at MH and Associates Counseling & Wellness PLLC, if you are currently endorsing suicidal or homicidal thoughts with an active plan or intent, attempted suicide in the past 2 years, admitted into a psychiatric hospital for mental health challenges in the last 5 years, hearing or seeing things that are not there, substance abuse behaviors, or eating disorders. If it is unclear if you are a candidate for tele-mental health support, feel free to contact me at mharris.zoom@gmail.com.

**If you are currently in a mental emergency or crisis and experiencing thoughts of suicide, homicide, self-harm, or have a plan for suicide, homicide or self-harm, please call 988 now or go to the nearest emergency room for assistance.**