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New Client Inquiry form
 
Welcome to Counseling4Life! We are a group of therapists dedicated to our profession and passionate about helping people.

We offer in-person and Telehealth sessions!  Our office administrative hours are: 
Monday - Thursday 8:00am - 5:00pm
Fridays 8:00am - 3:00pm.  
You can contact us via phone or text at 210-209-0642.

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电子邮件地址 *
Before you proceed, the following services are outside our scope of practice.  If you would like a referral, text or call us at 210-209-0642.
* Services pertaining to legal matters or aid in obtaining disability paperwork

* Eating Disorders

* Court ordered counseling or custody evaluations

* Letters for emotional support animals

* Psychological evaluation or testing

Client's Name *
Client's date of birth *
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Select Client's age range: *
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Client's Gender: *
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PRIMARY CONTACT NUMBER: *
Do you agree to receiving Text Communication from COUNSELING4LIFE? *
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Please Type the Clients Zip Code Below: *
Your relationship to the client: *
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In the text box below tell us the reason(s) for your Inquiry with Counseling4Life. Be as descriptive as you can. The information you provide will help us ensure we match you with a GREAT counselor!  *
Which location? *
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How did you hear about Counseling4Life? *
Which healthcare provider can we thank for recommending Counseling4Life? (Provider and/or practice name or N/A if you were not referred by a healthcare provider) *
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