LifeWorks Appointment and Information Request

(By submitting the following you are requesting to be contacted by LifeWorks. Your information will not be sold and will be kept strictly confidential.)

If you already know you are ready to begin counseling, or just want more information about us, please complete and submit the form below. For immediate assistance, call 214.357.4001, or contact us by email!

*First Name   *Last Name   Address   Suite/Apt   City/State/Zip    Phone: *Cell   Home   Work    May we leave a message at this number?  Yes   No   Fax   email     *Required Field!   LifeWorks offers client counseling by appointment only, Monday through Friday. Other times and Saturday sessions may be arranged according to counselor availability. Please select the times you are available for counseling from the following list.    I have a flexible schedule, I am available almost anytime.    I am available almost anytime during the day.    I am available in the evenings.    I am available at lunchtime.    Other? Please note in the comment box below. If you make an appointment with a LifeWorks counselor, we ask that you respect our cancellation policy and give us a full 24-hours notice if you need to cancel. All clients are asked to commit to this policy when scheduling a session and will be asked for a credit card number, for use in the event of a no-show or last-minute cancel. For cancellations less than 24-hours in advance, a rescheduling fee of the half the full session cost may be used if the appointment can be rescheduled with counselor within the same week.   I would like to schedule counseling for: Please Choose One Individual Counseling Family Therapy Marital Therapy Group Therapy Lifestyle Coaching Other   Please select the specialties that fit your needs: Please choose up to three Abuse/Trauma ADD/ADHD Addictions/Compulsive Behavior Adolescence Anxiety Blended Family Chemical Addiction Children, Play, and Filial Cultural Differences Depression Divorce Eating Disorders Elder Care Marriage & Family Parenting Spouses of Addicts (Codependents) Other   Do you have a counselor preference? Please choose up to three Melanie Wells Harry Cates Abbie Chesney Chris Jones Mary Sanger Ly Tran A Student Intern Not Sure   How did you hear about LifeWorks? Please Let Us Know Email Notice Internet Search Friend Brochure Seminar Referral Link Therapist Newspaper/Magazie/TV Other - Note Below What else should we know? Please tell us below: Additional Comments   For your safety, please type the exact text in this field Reload Image