Contact

Let’s get you the mental health care you deserve.

If you are NOT a current client, please complete the form below to request your free 15-minute consultation.

hello@healingpathwayshouston.com | (832) 895-9358, ext. 1

Memorial (main) office: 9235 Katy Freeway, Suite 140-160, Houston, TX 77024

Upper Kirby: 4151 Southwest Freeway, Suite 720, Houston, TX 77027

Full Name

First Name

Last Name

Client name, if different from the person completing this form. (If not applicable please enter N/A).

First Name

Last Name

Partner's name, if inquiring for couples counseling. (If not applicable please enter N/A).

First Name

Last Name

Who are you inquiring about services for?

Individual

My child

Couples/family therapy

Other

Client's Date of Birth

YYYY

Phone number

(###)

###

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What is your preferred method of contact?

Preferred Location

Do you have a preferred therapist you'd like to work with?

What insurance will you be using?

Please note, our self-pay rates range from $50 - $180 per session at this time.

Insurance ID, Group #, and Primary Insurance HolderDOB:

We understand knowing your financial responsibility is important prior to attending therapy. To help us accomplish this, please provide your ID, Group #, and Client DOB below to verify benefits in advance with our practice.

In a few words, describe what brings you to therapy?

We'd love to know how you heard about us!

What is your availability for sessions?

This includes time/day preferences.

What are your therapeutic preferences?

This can include what you're looking for in a therapist, a specific therapist at Healing Pathways of Houston, and/or modalities of therapy.

Would you like to opt into our Weekly Newsletter for all HPH updates?

Yes