skip to main content

Service Request

Telebehavioral Health Service Block Request Form

This form is for organizations interested in the telebehavioral health counseling time blocks.


Note: This form is not for patients. It is for health care providers interested in behavioral health services for their organization.

  • If you are an individual looking for counseling or other behavioral health services, please call us at 979.436.0700 for a free and confidential screening.
  • If you are in crisis, please call 9-1-1 or visit your local emergency room.