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Client Pre-Screen
For potential clients, please complete the following so that we can start the process and make sure that we're a good fit.
Name
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Last
Email
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Phone
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What Brings You To Therapy?
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In a few words, tell me about why you are seeking counseling.
Your Preferred Day(s) / Time(s)
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Monday
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Provider Name
If you selected EAP or Insurance Provider above, please provide your provider here.
Phone
This field is for validation purposes and should be left unchanged.
Glenda L. Rice, MA, LPC
Psychotherapy and Consultation
5909 West Loop South, Suite 470
Bellaire, TX 77401 (
Map
)
713-664-5513
• 866-888-6283 (fax)