CONTACT US

• 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)
• SNAPP Form (PDF)

New Patient Child and Adolescent Admin Forms

• Form for Lynn Ayers 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 W. Walker Peacock, Psy.D.
• 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)

New Patient Adult Admin 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 W. Walker Peacock, Psy.D.
• 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)