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Where did you hear about us? *googleSocial MediaPsychology TodayFamily / FriendMilitary BaseDoctorOther

Preferred Location *San Antonio, TexasWoodmen RdFountain officenorth academy officeTeletherapy with Virtual Visits Only Please

Requested Therapist *

What type of insurance do you have? *We currently work with Aetna PPO, Cigna PPO, Triwest, and United Healthcare along with self pay clients. Please include your insurance benefits number to ensure timely claims processing. We are not credentialed with any HMO/Medicaid/Medicare plan and are unable to see clients with this type of insurance coverage. It is the client's responsibility to verify insurance benefits.

How can we support you? What have you been experiencing and for how long? *

If you have had therapy in the past, what was your experience like? *

Have you been hospitalized for psychiatric concerns? *If so, when and for how long?

Have you previously been diagnosed with a disorder or particular mental health challenge? *If so, kindly provide a date range and name or details about the disorder.

Are you currently taking medication prescribed to treat mental health? *If so, kindly list medications.

Therapy Preference *In PersonTeletherapyFirst Available