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The Mindset Counseling Group
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What type of treatment?
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Medication Management
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Therapy Appointment
TMS Therapy
Spravato® (Esketamine) Treatment
General for Depression/Anxiety
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Who is the treatment for?
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Please summarize symptoms and when/where those symptoms are happening
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In general, which days/times are best for appointments? (Check all that apply)
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Are there any preferences or specialties you are looking for your therapist to have?
What type of appointment?
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Medication Management
Substance Use Treatment
Therapy Appointment
Psychological Testing
TMS Therapy
Spravato® (Esketamine) Treatment
General for Depression/Anxiety
Other
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Referred by
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example@example.com
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Best time to be reached?
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Preferred location(s)
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Killeen, TX
Telehealth
Clinician name
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Credentials
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LCSW
LMFT
LMHC
Psy.D.
Ph.D.
ARNP
MD
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Clinician email
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example@example.com
Name of organization
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Type of service for referral
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Telehealth
Adult counseling
Addiction treatment (IOP)
Addiction treatment (EOP)
Depression and/or anxiety treatment
Couples counseling
Family counseling
Older adult services
Child & adolescent services
Youth IOP services
Youth EOP services
Psychological assessment
Medication manangement
TMS therapy
Esktamine nasal spray
OWI classes
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