Provide your details below and our Intake Specialist will reach out to you to connect you to a counselor.

First Name *

Last Name *

Phone *

Email *

Do you Prefer In-Office or Virtual? *

Virtual Appointment

In-Office (Lubbock)

In-Office (DFW)

What type of therapy are you looking for? *

Adult Individual

Child Individual

Couples Counseling

Family Therapy

Do you have insurance? *

Yes

No

Insurance Type

If you have insurance, please provide your member ID and date of birth so we can speed up insurance verification for you.

What is the best time to reach you by phone?

Early Morning

Late Morning

Early Afternoon

Late Afternoon

What can we help you with today? *

*If you are in crisis, please call 911.

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