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Welcome! We are looking forward to getting to know you. To match you with a counselor who uniquely meets your needs, we ask a lot of questions at the beginning. We estimate that this form will only take 3-5 minutes of your time!

Let us know what you need right now.

Services *

Our sister company, Mindfully Texas, accepts insurance.

How would you like to pay for your therapy services? *

Our standard direct pay rate for services is $150 per session. We also offer limited discounted rate sessions without requiring proof of need.

Fees *

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Looking for low cost counseling? to request affordable services offered by our graduate student Interns.

Therapy Austin has office suites north and south of the river. If you have a strong preference for one or the other, please indicate that below. We also offer teletherapy as an option.

Branches *

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Different challenges bring people to therapy and you can find different treatments for each of them. Of the long list below, please mark up to ten issues that apply to you so that we can match you with a therapist skilled to work with you.

Issues *

Special techniques or experiences that I’d like my counselor to use in sessions

Our staff is diverse in many ways, including differing types of experience and counseling techniques. If you have a preference, let us know so we can consider your desires when we match you with a counselor.

Techniques

When matching you with a counselor, we know that there are traits that are important to consider. Let us know which descriptors appeal to you when imagining a compatible therapist match.

Qualities

In this section, please mark as many options as you possibly can. Available appointment times can be a limiting factor when making good client-counselor matches and we want you to have the best possible outcome at Therapy Austin.

Availability *

Day	Morning	Afternoon	Evening
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What is your preferred frequency of therapy?

Please note, the recommended frequency of therapy sessions will be determined based on your preferences, treatment goals, and clinical recommendations at the time of intake and will be discussed with you.

Yes No

Select your time preference

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The following groups are enrolling: *

Ensuring the privacy and security of your information is a top priority for us. You can rest easy, knowing that we take every precaution to provide an online form that is secure and HIPAA-compliant.

Hate spam? So do we! We promise we will not sell your data to any third parties.

Personal Details

{{ selectedService === '65cba7129291323ea5eea9be' ? "Teen's First Name" : "First Name" }} *

{{ selectedService === '65cba7129291323ea5eea9be' ? "Teen's Last Name" : "Last Name" }} *

{{ selectedService === '65cba7129291323ea5eea9be' ? "Teen's Phone Number" : "Phone Number" }} *

Email *

Teen's Email

{{ selectedService === '65cba7129291323ea5eea9be' ? "Teen's Zip Code" : "Zip Code" }}

{{ selectedService === '65cba7129291323ea5eea9be' ? "Teen's Date of Birth" : "Date of Birth" }} *

Guardian First Name *

Guardian Last Name *

Guardian Email *

Guardian Phone Number *

Partner Details

Partner First Name *

Partner Last Name *

Partner Phone Number *

Partner Email

Partner's Date of Birth

Is there anything else you'd like to tell us so we can help make sure your teen gets the best quality care?

Is there anything else you'd like to tell us so we can help make sure you get the best quality care?

I understand that Therapy Austin does not accept insurance payments, but I can work with my insurance company directly to seek reimbursement for my sessions or use an FSA/HSA card. *

I verify that this form was filled out by the person who is seeking services, not on behalf of someone else. *

I consent to receiving occasional messages from Therapy Austin, including from the intake team for scheduling purposes. Reply STOP to opt out. *

Thank you for reaching out. We will contact you soon.

In the meantime, if you have any other questions, please call us at 512-201-4501

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Services *

How would you like to pay for your therapy services? *

Fees *

Branches *

Issues *

Special techniques or experiences that I’d like my counselor to use in sessions

Techniques

Qualities

Availability *

What is your preferred frequency of therapy?

What is your insurance carrier?

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The following groups are enrolling: *

Personal Details

Partner Details

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Services *

How would you like to pay for your therapy services? *

Fees *

Branches *

Issues *

Special techniques or experiences that I’d like my counselor to use in sessions

Techniques

Qualities

Availability *

What is your preferred frequency of therapy?

What is your insurance carrier?

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The following groups are enrolling: *

Personal Details

Partner Details

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