After submitting a referral for counseling, please complete the following forms so we can begin services as quickly as possible. 

Informed Consent to Treatment

This form is required before any counseling sessions or intake appointments can occur. There is an option for you to download your completed form or have it sent to you. Please make sure you hit Submit! 🙂


Consent for Release of Information

This form is ONLY needed if you are asking us to communicate with someone who is not considered a legal guardian or medical consenter (e.g. psychiatrists, daycare teachers, school counselor, attorney, etc. ). We are bound by HIPAA and not able to confirm or deny that we know the patient if we don’t have this. 



  • Who can complete the forms?

    Children in Foster Care: Forms can be completed by a legal guardian or medical consenter (DFPS Caseworker, placement agency case manager, caregiver)

    Children not in Foster Care: Forms can be completed by a legal guardian

    Adults: Forms can be completed by you–please use “N/A” for questions that don’t apply.

  • I submitted the forms. What do I do now? 

    As soon as you complete the forms, please let your assigned counselor know so they can add them to our records and get started right away!

  • Is anything else needed before counseling can get started? 

    For children in Foster Care: Yes. Please send removal affidavit and court documents showing medical consenter status to your assigned counselor. As soon as these come through, we can share links with the treatment team to access notes directly. These links will update automatically as notes are submitted—which makes life a whole lot easier!

For questions about DFW & Houston please contact Chase Chick, LPC, CEO
[email protected]
(903) 316-0472

For questions about all other regions of Texas please contact Rachel Preston, LPC-S, COO
[email protected]
(972) 559-9227