Ready to ignite therapy?

Name *

First Name

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Select your preferred communication method(s).

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I confirm that I am either (a) at least 18 years old and seeking therapy for myself, or (b) the parent/legal guardian of a minor seeking therapy. *

Clients must be 18 years old to schedule therapy for themselves. A parent or legal guardian may schedule on behalf of a minor.

Yes

I understand the standard rate of online therapy is $125 ($65, if the reduced student rate applies). I understand that insurance is not accepted. *

Yes

I confirm that I am not currently experiencing suicidal or homicidal thoughts with the intention of acting on them. If I were, I understand I should call 911, go to the nearest emergency room, or dial/text 988 for immediate support instead of using this form. *

Yes

By submitting this form, I consent to be contacted by Ignite Therapy of Austin regarding scheduling a consultation or therapy session. *

Yes