FREE CONSULTATION

Free Consultation Form

Please schedule your 15-minute free consultation call. During this time, we’ll review your goals and help match you with the therapist who best fits your needs.
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
E-mail*
example@example.com
How did you hear about us?*
What service/s are you looking for?*

EMDR TherapyIndividual CounselingCBT for Insomnia (CBTi)BiofeedbackBiosound® TherapyCouples Therapy Avail Virtual OnlyThe Gottman 7 Principles SeminarPlay TherapyChild-Parent Relationship Therapy (CPRT)Other
COUPLES THERAPY SCHEDULE: Please select a date and time that works best for you to be contacted by our couples therapist to have a Zoom consultation. We strongly encourage both partners to attend this virtual meeting.*
Please Note: Couples Therapy and Biosound Therapy are private pay services. Insurance claims are not submitted for these treatments
We do not specialize in: psychological testing, evaluations or testifying for child custody cases, court expert witness, and any requests outside our license scope of practice. Please explore your needs candidly during the consultation so we may serve you better or help you find the right professional.
Who are the services for?*

MyselfMy childMy partner and IOther
How old is you child?*
According to Texas Administrative Rule §681.35, therapists must have a copy of the custody agreement when parents are divorced, prior to the start of treatment. More information here.
Please select the option that applies to your situation*

Not applicable, parents are marriedYes, I understand. We are divorced and both parents will consentYes, I understand, I am the sole consenting caregiver on the decreeNo. I will reach back once I have the final decree. (We can still do Free Consultation for information).
Please provide the other consenting party's information:
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Service location*

Plano In-personFort Worth In-personVirtual Texas wideI'm open to virtual for the right matchCouples Therapy - Available virtual only
Are you using insurance? Note: Biosound and Couples Therapy are private pay only services. *

YesNo
Select from the list (varies by provider). We are not in-network with Medicare, Medicaid or EAP's. *
Other insurance:*
You will be contacted by one of our onboarding liaisons depending on the date you prefer for the phone call. Please select your preference of what days you are available for a free 15 minute phone call consultation:*

Mondays/Wednesdays/Fridays/SundaysTuesdays/Thursdays
Please select only one date and time from this calendar for the 15 minute phone call consultation.*
Please select only one date and time from this calendar for the 15 minute phone call consultation. *
Please select the therapist/s you are considering. All therapists can do virtual sessions, if they also practice in-person, their location is listed*

Whoever is the best matchLupita Lopez -PlanoFlora Lai /賴沅萱 -PlanoAshley Hembrock -PlanoSelena Iturbe -PlanoGriselda Ruvalcaba -PlanoShlomit Oliel -Fort WorthCarla Pinto -Fort WorthSara Aguilar -virtualAbby Zandevakili -virtualDr. Regine Chung -virtualMaribel Faucett -virtualVeronica Petty -virtual
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Free Consultation Form

Please provide the other consenting party's information: