People who are successful in life, are successful at self-management.
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(713) 621-9515
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Printable map for the Galleria location (PDF)
Printable map for the Sugar Land location (PDF)
Instructions for our Automated Phone System (PDF)
Contact Forms
Contact a Clinician
Schedule an Appointment
Request a Prescription
Schedule a Presentaion
Financial Services
Comments or Concerns
CONTACT
Online Forms
Contact A Clinician
Schedule An Appointment
Request a Prescription
Schedule A Presentation
Financial Services
Comments or Concerns
Standard Forms
Authorization to Release Records
(PDF)
Authorization to Release Family Member Records
(PDF)
Consent to Treat
(PDF)
Consent to Treat with Medications
(PDF)
Credit Card on File
(PDF)
Email Consent Form
(PDF)
Mood Chart
(PDF)
Monthly Billing Aggreement
(PDF)
SNAPP Form
(PDF)
Child and Adolescent Forms
Form for Lynn Ayres M.Ed
(PDF)
Form for Paul J. Clear, Ph.D.
(PDF)
Form for Yael R. Ebenstein Ph.D.
(PDF)
Form for Elaine Frankel LMSW, ACP-PR
(PDF)
Form for Sophia K. Havasy Ph.D.
(PDF)
Form for Kimberly Kjome, M.D.
(PDF)
Form for Linda Narun M.A., CCC-SLP
(PDF)
Form for Diane N. Roche Ph.D.
(PDF)
Form for Dr. Scott
(PDF)
Form for Lesley Solomon M.A., LPC
(PDF)
Form for Ron Swatzyna Ph.D., LCSW
(PDF)
Form for Jay D. Tarnow M.D.
(PDF)
Form for Lourdes M. Valdés Ph.D.
(PDF)
Adult Forms
Form for Lynn Ayres M.Ed
(PDF)
Form for Paul J. Clear, Ph.D.
(PDF)
Form for Yael R. Ebenstein Ph.D.
(PDF)
Form for Elaine Frankel LMSW, ACP-PR
(PDF)
Form for Sophia K. Havasy Ph.D.
(PDF)
Form for Kimberly Kjome, M.D.
(PDF)
Form for Linda Narun M.A., CCC-SLP
(PDF)
Form for Diane N. Roche Ph.D.
(PDF)
Form for Dr. Scott
(PDF)
Form for Lesley Solomon M.A., LPC
(PDF)
Form for Debra Stokan M.D. (PDF)
Form for Ron Swatzyna Ph.D., LCSW
(PDF)
Form for Jay D. Tarnow M.D.
(PDF)
Form for Lourdes M. Valdés Ph.D.
(PDF)