Wait List : Amber N. Pilkington, M.Psy., LPC-S

If you are in crisis please contact 988, 911 or go to your nearest hospital emergency room.

Thank you for your interest in my practice. In order to make sure that current clients have enough times available to schedule, we hare now pausing new client and creating a waitlist. The wait time is estimated at 6-8 weeks but it could be more or less.

If you are in crisis right now, please don't fill this out and wait.

This form isn't watched around the clock. If you're thinking about hurting yourself, or you're frightened by what's going on in your head, or something has happened and you need someone tonight, I don't want you sitting alone with it while an email waits in an inbox. Here is who to call. All of these are open right now.

988 Suicide & Crisis Lifeline — call or text 988. Around the clock, free, in English and Spanish.

Crisis Text Line — text HOME to 741741.

If someone's life is in danger, call 911 or go to the nearest emergency room.

If you are not in crisis but need to see another therapist sooner please click on the link below to see crisis resources and information about finding a therapist, questions to ask, etc.

Crisis Resources & Other Therapy Referral Sources

Before we begin, please check each of the boxes below to confirm your understanding before you fill out the rest of the form.

I am not in crisis and am safe to wait for a therapy appointment.

I will be located in Texas at the time of our appointments. (LPC's are licensed by state so we must see clients who are physically located in Texas at the time of our appointment.)

I understand that Amber N. Pilkington, M.Psy., LPC-S only sees clients via Telehealth (audio & visual) at this time.

I understand that Telehealth is not recommended for clients struggling with acute suicidality, homicidality, acute psychosis, dementia. I understand that cognitive capacity, history of violence or self-injury, substance use history, distance to emergency facilities, strength of the support network, whether client cooperate with a safety protocol might be reasons that I am referred to in in-person counselor.

I understand that Amber N. Pilkington, M.Psy., LPC-S only adults (18+) at this time.

I understand that Telehealth requires that I have the ability to attend sessions in a safe, secure, private location.

Your Full Legal Name

Email address

Date of Birth

Phone Number

What is the best way to contact you?

Phone Call

Text

What type of therapy are you requesting?

Individual Couples/Marriage Family

How will you be paying for therapy?

Private-Pay ($115 per 53-60 min session)

I cannot see Medicaid/Medicare clients who want to use private pay per their contract agreements with Headway.

Insurance

I am in-network with most major insurance companies (excluding Medicare/Medicaid/Tricare)

If you are using insurance what insurance do you have?

Please briefly describe why you are seeking therapy at this time and your goals for our time together.

If you have any questions or concerns you would like for me know/address/answer, please leave them below.

Thanks again for your considering me for your mental health journey. It truly is an honor. I look forward to talking with you soon when more session times open. Feel free to text me if you have any non-emergent questions or concerns. 210-241-0020.

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