Contact Us for Consultation or Appointment
After you fill out this order request, we will contact you to go over details and availability before the order is completed. If you would like faster service and direct information please contact us (281) 501-0109 or
Are you a new or existing customer?
I am a new customer
I am an existing customer
Seeking Information or Consultation
Consultation or Book Appointment?
Book First Appointment
If you are interested in a particular Therapist, Coach or Neurofeedback provider please select below.
Bryant Packard [Neurofeedback Provider]
Therapy Interaction choices? Note only very limited Face to Face will resume.
Face to Face ONLY
Face to Face
Video Assisted Therapy
What support are you reaching out for?
If using Insurance, please indicate which one below.
Preferred contact method
Questions and comments
How did you hear about us?
Never submit passwords through Google Forms.
This form was created inside of The Center for Authentic Healing and Counseling.