Appointment Inquiry Form

Currently we will only be scheduling new patient appointments for the In Restoration Programs. Please see the "In Restoration" Tab for more information. You may fill out the form below if you are interested in our In Restoration program. For existing patients wanting to schedule a follow up appointment, simply give us a call at 713-332-4388.

Dr. Stahl does not double book appointments. Your appointment time is reserved for you. If you need to cancel/reschedule your appointment, please contact the office at least 2 business days in advance to avoid being charged your full appointment fee.

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FUTURE PATIENT INQUIRY FORM: Please review and check off each of the below checkboxes to ensure this clinic would be a good fit to meet your needs. Also, please fill in additional information about the reason you are seeking care.

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Name: *

E-mail address: *

Telephone/fax: *

You are wanting to explore root causes for the symptoms you have been experiencing and are not looking to only medication as the answer to your mental health problems.

You are not in the midst of a mental health crisis that needs immediate attention and are able to wait to be seen. Please see our emergency contacts page under the heading Office Policies if you need immediate care.

You are seeking a more individualized and comprehensive mental health treatment plan.

You are aware that this clinic does not work with any insurance companies.

You have reviewed the In Restoration tab, watched the informational video and you are willing to make lifestyle changes in order to improve your mental health.

You have not been suicidal within the last 1-2 year and are not currently using illegal drugs (including THC) or are struggling with alcohol abuse.

Primary Reason for seeking care: *

If appointment is for a child, do both parents give consent to have the child evaluated? *

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I herby agree that my data entered in the contact form will be stored electronically, and will be processed and used for the purpose of establishing contact. I am aware that I can revoke my consent at any time.

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