New Patient Therapy Appointment Request Form
*Please note that this form is not a guaranteed appointment.
This form is the initial step to our intake process. Please fill out every question presented, as any incomplete answer may delay the intake process.
This form does not guarantee an appointment. This form intends to request an evaluation and determine whether we are the best fit for the patient.
*If you or someone you know is in an emergency crisis, dial 512-472-4357, or 911.*
Veterans Suicide Hotline: 1-800-986-1891
National Suicide Prevention Lifeline: 1-800-273-8255