Name *

First Name

Last Name

Phone *

(###)

###

####

Preferred Contact Method *

E-Mail

Phone Call

Location of Therapy *

Austin

Ft Worth

Virtual

No preference

Therapist to Contact *

Check one or more therapists to contact

Marie Gray LPC-S

Jasmine Trotter LPC

Madeleine Smith LPC-A

Jessica Chavarria LPC-A

Linda Love LPC-A

Sarah Newman LPC-A

Jamison Barton LPC-A

Ben Meyers LPC-A

Dexter Collins LPC-A

Megan Grisham LPC-A