New Client Request Form

*Please note:
1) I am not accepting new couples at this time, only individual clients.
2) In order to hire me as a psychotherapist, you must be a resident of Texas.

Thanks!

If you would like to set up a complimentary virtual consultation (20min) to co-determine if we might be a good fit for counseling work together, please submit the form below. It may take up to 2 business days for a response. 

Please note: counseling sessions are virtual unless otherwise arranged. Thank you! 

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Name *

Email *

Phone Number *

Would you prefer I contact you by email or phone number? *

• Phone
• Email
• No Preference

or to Name

Do I have your consent to reach out to you by the requested option above? *

• Yes
• No

Who referred you? (Optional)

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