Client Information and Consent Form- PLEASE READ CAREFULLY

  • Please include your preferred first name
  • MM slash DD slash YYYY
    Check all that apply.
  • If none, select "None".
    We have graduate students who get credit from their universities for not only seeing their own clients, but for observing other therapists in our practice working with clients. The intern will likely not engage in the session. They will process what happens in session after with the therapist so you will only be engaging with one therapist. You are agreeing to have them sit in, but it is not guaranteed that they will.
  • I HAVE READ THIS AGREEMENT IN ITS ENTIRETY AND AGREE TO ENTER IN TO THERAPY/COACHING AT HOUSTON RELATIONSHIP THERAPY.
  • We only send emails once or twice per month max.
  • This field is for validation purposes and should be left unchanged.