Request Form
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Let's get started! What services are you interested in?
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 *
What fee works for you?
Our standard rate for services is $150 per session. We also offer limited openings at discounted rates without requiring proof of need.
We do not accept insurance, but you can work with your insurer to seek reimbursement. We do accept FSA/HSA cards.
Fees *
Where would you like to meet your counselor?
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 *
I’m looking for help with…
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 *
Qualities I’d like my therapist to have…
When matching you with a counselor, we know that style, temperament and other personality traits are important to consider. Let us know which descriptors appeal to you when imagining a compatible therapist match.
Qualities *
What times are you available?
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 *
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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.
Select Your Therapist
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What group are you interested in?
The following groups are enrolling: *
How can your counselor reach you?
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
What is the best way to reach you?
Is there anything else you'd like to tell us so we can help make sure you get the best quality care?
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
