To schedule an individual or couples appointment or to obtain
additional information about any of these counseling services, please fill
out the form below or give me a call at 512 327-8196 . You may also email
me at
[email protected]. Providing individual and couples. Appointments are online only, allowing you to have an appointment from the comfort of your own home. Appointments are available online throughout the state of Texas.
Name: _________________________________________ Partner or Spouse's
name___________________________________
Problem seeking help for
____________________________________________________________________________________________
Phone number_________________________________________________________
Email address__________________________________________________________
Best time to reach you___________________________________________________
We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.