New Patient Request Form:
If you are a current or prior client with our clinic, please log in to the client portal OR contact our staff directly. If you are a new client, please complete the information below, and we will reach out to you shortly.
Personal Information:
Gender of Legal Record:*
Contact Information
Address
Provider:
Your Information is confidential. However, if you are uncomfortable fully describing your reasons for seeking services, please provide enough information so our staff can match you with the appropriate provider.
Insurance:
EAP Information:
Submit
Cancel

New Patient Request Form:

If you are a current or prior client with our clinic, please log in to the client portal OR contact our staff directly. If you are a new client, please complete the information below, and we will reach out to you shortly.
Personal Information
Contact Information
Phone

Address

Provider:
Please explain the reason you are seeking help at this time:
Insurance
Submit
Cancel
Clinic Address
1214 18th Street Suite B1
Hondo, TX 78861-1753
Clinic Phone No.
(830) 444-5064

Billing Phone No.
Business Hours
By Appointment