New Client Inquiry Form
Welcome to Untanglife Counseling!
Personal Information:
Gender of Legal Record:*
Contact Information
Address
Please select a Provider:
No preference
 
Your Information is confidential. However, if you are uncomfortable fully describing your reasons for seeking services, please provide enough information so our staff can match you with the appropriate provider.
Insurance:
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New Client Inquiry Form

Welcome to Untanglife Counseling!
Personal Information
Contact Information
Phone

Address

Please Select a Provider:
Please explain the reason you are seeking help at this time:
Insurance
Submit
Cancel
Clinic Address
6115 Camp Bowie Blvd. Suite 298
Fort Worth, TX 76116-5508
Clinic Phone No.
(817) 440-3622

Billing Phone No.
(817) 968-1905
Business Hours
By Appointment Only