How did you hear about us?
Therapy for Black Girls
Word of mouth
Other (Please specify...)
Do you prefer in-person or telehealth sessions? *Telehealth services are only available to clients who reside in the state of Texas.
Please tell me a little about what you want to work through in therapy:
Have you received therapy before? If so, please select all that apply.
Are you currently taking any medication for mental health reasons?
In the past
Name(s) of medication and dosage.
Do you plan to use insurance? *Self-pay rate is $150 for the initial appointment, and $125 for on-going 50 minute sessions.
Name of insurance:
Is there anything else I should know?
Please verify that you are human
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