Simple Initial Inquiry

We're here to help

Please fill in the form below and we will reach out to you within 24 business hours. We have both in-person and virtual mental health and nutrition services available.
Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Preferred method for contact when scheduling

Phone CallTextEmail
What format of services do you prefer?*

Virtual (telehealth)In-PersonEither one (virtual or in-person) is good.Other
Are you a Texas resident?*

YesNoI'm not sure
How did you hear about Discovery Counseling Austin?

Web SearchCurrent Provider (doctor, psychiatrist, etc.)TV commercial or Email PromotionFriend or other close personPsychology TodayTherapy DenYour InsuranceA current client referred youOther
Who are you contacting us about?*

MyselfA Minor childAn Adult Dependent
Date of Birth

MonthDayYear
Date
We just need a little more information about potential client you are contacting us about:
New Client Name:

First NameLast Name
New Client Relationship to you
New Client Birthdate

MonthDayYear
Date
New Client Contact Number (optional)

Area CodePhone Number
New Client Email (optional)
example@example.com
Since you are contacting us about an adult, please indicate if we should contact the new client directly or go through you.
Format of Therapy you are seeking (choose all that apply):

Adult Individual CounselingAdolescent Individual CounselingNutrition CounselingGroup CounselingRelationship Counseling (family, couples, etc.)Parent Coaching
Do you know which counselor you'd like to see? *if the counselor you choose is not accepting new clients, we will help you get connected with another provider.

Not sure, I’ll let you decide.Arden DanaAdrienne AhrRebecca CannonKady MaxwellMichele SharonLeAnn DapperErin Clark (dietitian)Nikol Metaxa RozenfeldDrew DubcakMaricela MayoHannah SimsJulia LaskerAlison SheltonJulie BiechlinLauren PachecoAmalia SeguraBridgit LakoskiAlli MichoKyla YorkoskiCandi SwartsJoyee UwangeAlya NaumovaLindsey DicksonBetsabe Perez MartijaChloé CortesBreanna WrightSarah WestermannJeremy BennickTaylor KronEdie Monceaux
Topics you want to explore in counseling:

Anxiety & WorrySubstance UseNutrition CounselingHighly Sensitive PersonStressAngerFood concernsDepression or Low MoodExercise AddictionBody ImageEating DisorderGrief and LossRelationshipsFamily ConflictCouples CounselingParenting SupportAdolescent concernsPostpartum (New Mom)Divorce RecoverySexualityLGBTQCultural IssuesSpiritualityWomen’s IssuesMen’s IssuesLow Self-EsteemAcademics/Work/CareerTrauma (Adult onset)CodependencyTrauma (Childhood)EMDRCBTCaregiver Stress (aging parent, health)Hormone Health & PCOSOther
Do you have specific scheduling needs?
Choose one
Please give us your preferred days & times for sessions:
Please list all days & times you can attend counseling so we have the best chance of connecting you with the best provider for your needs.
Payment Preference (choose all that apply)*

I plan to pay privatelyOut-of-network insurance benefitsAetna health insuranceUnited Healthcare or Optum InsuranceBCBS PPO insuranceBCBS UT: University of Texas or Student InsuranceWhole Foods Insurance (WEB TPA)I need help with payment options including reduced fee services and/or how to use my health savings account.
Private Pay
Sessions at Discovery Counseling Austin with our senior providers and specialists range from $140-$175.

Some providers offer some discounted slots ($40-$130) based on client need.
Out of network benefits
For any insurance that is out-of-network for us, we can provide you with a “superbill” which is a form that allows you to get reimbursement from your insurance (if they cover out-of-network services). You can always call your insurance and ask what out-of-network services would be covered.

*Provisionally licensed providers are typically not covered by insurance plans but every insurance is different.
Whole Foods EHN:
All of our providers are in-network with Whole Foods EHN, but you may want to contact them to confirm your benefits or have us do an electronic benefits check for you, see below.

All plans with EHN have a deductible that resets at the beginning of the year.

While your deductible is being met, you are responsible for the cost of services out of pocket. Once your deductible is met, your responsibility is 30% of the fees.

We do accept the Health Savings Account card from Whole Foods, which you can use to pay for your portion of the services.
Once you submit the form, we will get in touch with you to discuss payment options and see how we can help you get started with counseling.
BCBS, Aetna & United Plans

We are only In-Network for the specific insurance plans within each carrier. Every plan is different and some BCBS, Aetna & United plans may be "out-of-network" for us.

We offer an electronic benefits check as a courtesy to you but the information we get from the insurance company does not guarantee coverage. Any fees not covered by the insurance will be your responsibility.

Please be aware that if BCBS, Aetna or United is NOT your primary insurance (you have a different primary plan), we cannot bill for you.
BCBS UT Select and Student UT Plan

We are in-network with the UT plans and because we work closely with this plan, we already know your benefits. We do encourage you to contact the insurance and make sure your plan is active and current.

Keep in mind, if your plan goes inactive or your status changes at UT, your insurance will surely change so you MUST inform us. Any fees not covered by the insurance will be your responsibility.
We will do an electronic benefits check for your BCBS, Aetna or United plan with us. If you want to use insurance, we require benefits checked before you can be scheduled for your initial intake.

I give permission for you to check my benefits.
Insurance Benefits Check Information

All Fields must be completed for us to check your benefits
Name On the Insurance Card for the Primary Insured

First NameLast Name
Client's Date of Birth

MonthDayYear
Date
Member ID #
Group ID #
Customer Service Phone Number
Typically on the Back of the Card
Are you the Primary Insured or is your plan through a parent or partner?

Yes, I'm the primary insuredNo, my plan is through a parent, partner or someone else.Other
Provide the Date of Birth of the Primary Insured on the insurance Plan. For example: Client's Father, Spouse, etc.

MonthDayYear
Date
Image of Front of Insurance Card **If you DO NOT upload a picture, we can't quote benefits.

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Image of the Back of your Insurance Card **If you DO NOT upload a picture, we can't quote benefits.

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Our last question...
Please tell us a little about your goals and/or what you'd like to work on in therapy or nutrition counseling at this time? *
If you'd prefer not to share right now, please just type N/A
We look forward to helping you find the support you deserve!
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We're here to help

Insurance Benefits Check Information

Our last question...