Request Consultation | Shira Klazmer, LPC

What is a consultation request?
Prospective clients start with a free, 20-30 minute consultation phone call. Items we discuss during a consultation phone call: I will answer any questions you may have, we will discuss what you are looking for in therapy, I will tell you more about the way I approach therapy work, and we will decide together if it's a good fit before setting up your first therapy session. Please complete the form below to get started. After reviewing your completed form, I will email you within 24-48 hours to set up a time for the phone call.

First Name

Last Name

Gender Identity:

Preferred Pronouns:

Phone

Age:

Where in Texas are you located?

What are you hoping to accomplish through therapy at this time?

Have you been to therapy before? If so, what did you like/dislike about it?

Please type "yes" to acknowledge that you are aware that Shira does not accept insurance and that sessions fees are $165/session.

Do you have a requirement for session times or are you flexible? Note: Earliest session starts at 8AM and latest starts at 12:30PM Mon-Thurs. No evening sessions.

Options for session frequency are either weekly or every 2 weeks. Which do you prefer?

I offer in person and telehealth. What type of sessions are you interested in?

How did you hear about me? If direct referral, please name the person who referred you.

Anything else you'd like me to know?

Thanks for requesting a consultation!

​