To ask about becoming an new client with us, please fill out the form below. We will follow up with you via email or phone.

Name of Person Filling out this form:

Briefly explain reasons for seeking counseling:

Name of Insurance/EAP

Email: *

Check here to receive email responses

Member ID (If applicable)

Client Date of Birth *

Phone

Client Name: *

Our Address

Payment Information

I prefer to use my insurance

I prefer to self-pay

I have an EAP

Robyn Hicks

6801 Sanger Avenue, Suite 188C

Waco, Texas 76710

Phone: 254.304.9309

Fax: 254.320.0043