Appointments

For potential new patients:

Email is for initial contact only and does not constitute the establishment of a therapeutic relationship between provider and patient.

Name

First Name

Last Name

Name of Person Completing Form (if not the patient)

Date of Birth

MM

DD

YYYY

Telephone Number

(###)

###

####

Email Address

Preferred Contact Method

Email

Phone

I understand that

The clinic is out of network for insurance and is considered private pay

I must be physically located in Texas for care

Brief consultation prior to initial interview does not constitute a "doctor patient" relationship

Message

After information is submitted, your information will be entered into our electronic medical record system for scheduling and we will reach out for additional details/questions.

Appointments

Hours of Operations