If you would like to book an intake appointment or set up an initial free, face-to-face consultation to co-determine if we might be a good fit for counseling work together, please submit the form below. It may take up to 2 business days for a response. Thank you! 

Name *
Partner's Name
Partner's Name
(if applicable)
Additional Partner's Name
Additional Partner's Name
(if applicable)
Phone Number *
Phone Number
Please rate distress level 1-10, 10 being most distressed with a wish to schedule an urgent appointment. Note: this form is not monitored 24/7; it may take up to 2 business days to respond to your request. If you or someone you are worried about is in immediate danger of being harmed or harming themselves, please call 911 or go to an Emergency Room at the closest hospital.
Please indicate your current preference and availability for day and timeframe (e.g., Monday or Wednesday mornings between 8-11am).
Desired Services *
Please indicate which services you're primarily interested in experiencing so we can co-create a treatment plan that's customized for you.
Emergency Contact *
Emergency Contact
Please list a family member or friend you trust who does not live with you who could be reached in the event of an emergency.
(e.g., my mom, my partner's dad, family friend)
Emergency Contact Phone Number *
Emergency Contact Phone Number

privacy notice

Electronic communication such as email and text messaging may not be a HIPAA compliant secure and confidential means of communication and its use may compromise privacy and diminish service effectiveness. Please consider refraining from use of email and text to communicate confidential or sensitive information. Email and text messaging is only permissible as a means to answer scheduling or administrative queries, but not appropriate for any other clinical issues as the responder may not receive your message in a timely manner. 

If you are experiencing an emergency, please call 911 or: 

ATX 24-HR Crisis Hotline:
(512) 472-4357
Shoal Creek Psychiatric Hospital:
(512) 452-0361
St. David’s Pavilion Psychiatric Hospital:
(512) 867-5800
National Domestic Violence Hotline:
1 (800) 799-7233
ATX 24-HR SAFEline (abuse/domestic violence):
(512) 267-7233
National Suicide Prevention Hotline: 
1 (800) 273-8255
LGBT Trevor Project Lifeline:
1 (866) 488-7386
National Sexual Assault Hotline:
1 (800) 656-4673
Crisis Text Line:
Text “HOME” to 741741