Teen Request Form

What fee works for you?

Our standard rate for services is $150-$175 per session based on counselor experience level. We also offer limited openings at discounted rates without requiring proof of need. If you are unable to pay $150-$175 on an ongoing, weekly cadence, please talk to your counselor about reduced fee availability.

We do not accept insurance, but you can work with your insurer to seek reimbursement. We do accept FSA/HSA cards.

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.

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.

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.

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.

What matters most to you when matching with a counselor?

Here’s where the math comes in strong. Of all the topics we’ve asked you about, tell us what is most important to you. Whichever topic you choose will be given added consideration when we assign you to a counselor.

Almost done!

We just have a couple more questions before we match you with your counselor.

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.

If the adolescent doesn't have an email and/or phone, please put the guardian's email and/or phone in both places.