Interface-Samaritan Counseling Centers

Schedule Appointment

Please print the forms listed below and bring with you to your first appointment. If you are unable to print these forms please arrive 15 minutes before your appointment and we will provide the paperwork for you to complete.

Client History

Client Information

Payment Information

Consent for Services

Notice of Privacy Practices Receipt

Notice of Privacy Practices

 

Home Office:  4803 San Felipe • Houston, TX 77056  |  T: (713) 626-7990   F:  (713) 627-7715 | Email: info@interface-samaritan.com

Spring Office:  6823 Cypresswood Drive • Spring, TX 77379  |  T: (281) 376-8006   F:  (281) 376-8008 | Email: info@interface-samaritan.com


 

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