CRC Austin - Information Request
This form should take less than 5 minutes to complete.
All information submitted is encrypted, secure (SSL & this form feeds into a HIPAA compliant and encrypted version of G Suite). After you fill this form out, you will receive a response within 1 business day. (Note: If you are in crisis, please call 911)
Name *
Your answer
Email *
Your answer
Phone Number *
Your answer
I am interested in making an appointment for: *
I am looking for help with: *
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Briefly tell us what is prompting your desire for counseling at this time. *
Your answer
What appointment "windows" work best for you? *
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Which office location works best? *
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Do you already have an idea of which therapist you would like to work with?
Your answer
How do you prefer we communicate with you in order to schedule an appointment? *
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Thank you for your inquiry.
We do not accept insurance at the Center for Relational Care. However, we offer a range of services at different fees depending on experience level ranging from $40-125 per hour. We will contact you by the next business day to explore how CRC therapists might serve you.
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