Name *

First Name

Last Name

Phone *

(###)

###

####

Type(s) of therapy needed *

Child or Adolescent Therapy

Adult Individual Therapy

Couples Therapy

Family Therapy

Unsure

Psychological Evaluation (Immigration)

Preference of services *

Online (*we only offer therapy virtually)

Preferred language *

English

Spanish

Either

I mix both (Spanglish)

Preferred therapist(s)

Stephanie Páez (unavailable /maternity leave)

Katia Husemann (unavailable)

Marilu Navarro

Xochitl Gamas

Unsure/Need help choosing the right person

Do you live in Texas?

Yes

No, I live in another state