Anger Management Institute of Texas

For fastest service, please complete the form below and click on the Submit Form button on the bottom of the page. Once we receive your information, we will contact you to make an intake and assessment appointment.


Your Name:
EMail Address:  
Reason for Referral to Anger Management:
Currently receiving mental health services?
If yes, please explain:
How did you hear about us?
Your primary language:

Your Address:
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Date of Birth (MM/DD/YYYY):
Age:
Guardian's Name (if under 18):
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Your privacy and confidentiality are important to us. We take reasonable precaution to ensure that your personally identifiable information remains secure. If you have any questions regarding the use of your information, please contact us by telephone at (281) 477-9105.

 


Visa, MasterCard, American Express, and Discover cards gladly accepted