512/507.1518     3534 bee cave road, suite 114, austin, texas 78746     art@austinrelationshiptherapy.com

© 2009 Austin Relationship Therapy
Austin Relationship Therapy
Thank you for your interest in therapy.

Please take a moment to fill out the following information
to receive your free consultation.

Once we have received your information
we will contact you to schedule a time to talk.

Depending on availability some appointments are available
in-person while some may be conducted over the phone.

Please note that the consultation is not a therapy session.
It is intended to be a time to get to know each other
and to see if working together is optimal for both parties.

We look forward to hearing from you!
Name:
Email Address:
Our initial response to you will be by email.  If you wish to be contacted only by phone please check here:
Phone Number:
Ok to leave a message?
Yes
 No
How did you hear about us?
Word of Mouth: Who?
Agency
Other:
Internet
Therapist Preference:
Megan
 Erin
 No Preference
Blake
Primary reason for seeking therapy:
I'd like to know more about the following:
By checking this box I acknowledge that this consultation is not a therapy session and I will not be a client of
Austin Relationship Therapy if I participate in this consultation.  I understand it is a time for me and an ART
therapist to get to know one another and see if working together is optimal for both of us.
Free Initial Consultation