Contact Us
Please fill in the answers below and we will get back to you soon, or you can call the office at 281-810-9775
Name of person completing this form
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
Who are services for?
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First Name
Last Name
What is their date of birth?
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Month
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Day
Year
Date
Why are you seeking therapy at this time?
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Do you have a preferred therapist?
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Barbara Lee
Heather Ryan
Lee Ann Krause-Henry
Madeline Minor
Other
What insurance would you like to use? We are credentialed with the ones listed below.
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Aetna
Blue Cross Blue Shield
Cigna/Evernorth
Optum/United
Medicare
Out of pocket
How did you hear about Blue Horizon Counseling?
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