New Patient Forms:


Call Us: 214-742-0900

If you will be attending a session you will need to fill out an intake form. If you're not sure which one to use please use to following description to give you guidance -

New Patient Intake Form - Adult : Anyone who is over the age of 18 will use this form before attending counseling sessions. Please note that only one form should be used per person.

New Patient Intake Form - Child : This form should be used for anyone under the age of 18 and should be completed by the parent or legal guardian of the child attending. If the parent would like to join the child in the sessions they will need to fill out an adult intake form for themselves. 

If you have any questions or concerns regarding these forms please feel free to give us a call at (214) 742-0900 or email us at

Refreshing Times Counseling Center