Application For an Appointment

Please answer all of the questions below to schedule your appointment.

Once you submit the form, someone from our office will call you to confirm the day and time of your appointment. We thank you for your patience.

All information is kept secure and confidential

Thank you for choosing Rio Grande Counseling & Guidance Services

Health Insurance Information

To further verify your insurance information, we will need the following:

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Do you require special accommodations for a disability or any special cultural needs?
If yes, Please Explain Below
What are the three best days of the week that are good for you to have your first appointment us?
What are the three best times in the day or evening that are good for you to have your first appointment us?
Please tell us why you want to see us?
Have you been recently discharged from any hospital?
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