Brave Child and Family Therapy of Austin

Brave Child and Family Therapy of Austin Send Message

Who would be receiving care?

Someone else

Your info

First name

Last name

Phone

Name you go by

Date of birth

State

Select the state you live in

Reason for care

Why are you seeking therapy for your family?

Anxiety Attentional difficulties Anger Management Behavioral Issues/School Behavior Coping skills for big emotions Family Therapy Neurodiversity Neurodiversity: ADHD - Attention Deficit Hyperactivity Disorder Neurodiversity: Autism/Autism Spectrum Disorder Neurodiversity: Obsessive-Compulsive Disorder ODD - Oppositional Defiant Disorder/Conduct Disorder Parenting/Discipline/Setting Boundaries Parent-Child Interaction Therapy (PCIT) Supportive Parenting for Anxious Childhood Emotions (SPACE)

Administrative

Referral source

Enter how you were referred to our services

We would love to send a thank you to whomever shared about Brave Child and Family Therapy of Austin with you.

Please feel free to list their name and any contact information if you have it here.

Client Preferences

Is there anything else the practitioner needs to know for your consultation call?

Limited to 600 characters

Please check the caregiver's current marital status.

Legal documentation and consent are required before therapy begins. We are legally required to obtain a copy of the documentation that outlines each caregiver’s consent rights.

Divorced Domestic Partners Married Never Married Separated or Pending Litigation Widowed

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.