Virtual & Walk & Talk Therapy Waitlist

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Hey there! Thank you for your interest in starting therapy. Please fill out the form below and we will be in touch when spots open up.

Name and pronouns: *

Phone Number *

Email Address *

Reason for seeking treatment? *

Is it okay to text the number above? *

Yes

Is it okay to email the email above? *

We do not take insurance, however we are able to provide you with a receipt if you'd like to seek reimbursement on your own. Fees vary by therapist. The initial consultation sessions are complimentary and subsequent sessions are $140 for individuals $160 for couples.
*

Please confirm you have read and understand this.

Our therapists are only able to meet with clients who are current residents of Texas. Please confirm which state you are a resident of.
*

Texas

What service are you interested in? *

Virtual Individual Therapy

Virtual Couples Therapy

Walk & Talk Individual Therapy

Hybrid of Virtual & Walk & Talk

In Person/In Office

Required

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Open Haus Therapy. Report Abuse

Forms