Schedule a Consultation

Ensuring a good match with your therapist may be the most important task of therapy. Striving for a good match with my patients is a priority of mine. I appreciate your thoughtfully answering the form below to help us determine our fit together. If you are inquiring on behalf of someone else, I would politely ask that you guide them to complete the form for themselves.

I aim to reply by email within a business day. If you don't hear from me within that time, please check your spam folder to ensure my response did not get snagged by a filter.

Finally, please note this form is not HIPPA-compliant. If you have privacy security concerns, please feel free to leave me a voicemail.

Name

First Name

Last Name

Email

Phone

(###)

###

####

Insurance

I'm currently in network with Aetna PPO and Tricare East. I am glad to assist with submitting for reimbursement of services from an out-of-network provider. Please note that my policy is to provide couples therapy on a private pay basis.

What do you do for work and for how long have you been doing this?

What problems are leading you to seek help now?

What has been your prior experience with professional help?

What are some key traits of a therapist that matter to you?

What are your scheduling needs and preferences?

Location & Contact

Broadway Theater Building

4940 Broadway, Suite 330
San Antonio, TX 78209

tim@drtimpeterson.com
(210) 588-0298