Personalized Therapist Matching Form

Personalized Therapist Matching Form

We will send you a personalized email with the results within 24 hours
Client Information:
Full name*

First NameLast Name
How did you hear from us?*
Current Date

MonthDayYear
Date
Date of Birth*

MonthDayYear
Date
Age (in days)
Age (in years)
For minor clients, please provide the parent or legal guardian's information
Parent's full name*

First NameLast Name
Phone number*
E-mail*
for minors, add parent's email
What brings you to therapy?

AnxietyDepressionTraumaInsomniaRelationship issuesGriefChronic IllnessCouple's CounselingParentingLife TransitionsADHD SymptomsChildhood TraumaOther
Who is therapy for?*
Do you prefer a therapist who speaks a specific language?

EnglishSpanishFrenchMandarin
Are you looking for a therapist with expertise in any of the following?

Play TherapyEMDRCouples CounselingTraumaCultural IssuesIdentity ExplorationCBT for InsomniaPerinatal HealthBiofeedbackBehavioral IssuesAutism Spectrum DisorderChronic IllnessParenting SupportOther
Are you open to therapy:
For in-person sessions, which location is most convenient?

Plano, TXFort Worth, TXEither
What days and times are you generally available for therapy?

Weekday mornings (8am–12pm)Weekday afternoons (12pm–4pm)Evenings (4pm–7pm)
Payment Method:

Private pay / out-of-pocketInsurance (please select your provider)
Note: Couples Therapy is a private-pay service.
Select your insurance (not all therapists take every insurance below). We are not EAP providers, and we are not in network with Medicare, Medicaid.

AETNABlue Cross Blue ShieldCignaOscarOxford Health PlansUnited Health CareOther
Is there anything else you'd like us to know before matching you?
Should be Empty:

Personalized Therapist Matching Form

Client Information:

For minor clients, please provide the parent or legal guardian's information

Note: Couples Therapy is a private-pay service.