Name *

First Name

Last Name

Privacy Policy and Terms and Conditions: *

Consenting/opting-in is simply for AATS to follow up with your regarding your request for services (and possibly reminder emails for any scheduled appointments). We will not send you any marketing materials, newsletters, or any other automated messages. You can read more about our privacy policy and terms and conditions at https://www.attunedaustintherapyservices.com/aats-privacy-policy.

Yes, I consent/opt-in to receive phone calls from AATS

Yes, I consent/opt-in to receive SMS/text messages from AATS. I understand that message frequency varies and data rates may apply. I understand that I may opt-out by informing AATS at any time. I understand that consent for SMS/text messaging is not required to proceed with services.

I agree with the Privacy Policy and Terms and Conditions

Phone

(###)

###

####

I am interested in working with the following providers:

Ariana

Caroline

Jessie

Elizabeth

Are you seeking a provider that accepts BCBS?

Yes! This is a must.

Yes, but I am open to private pay as well if it is the right fit.

No, I expect to be a private pay client.