Ready to Get Started? Let’s Connect

First name

Last name

Email address

Phone number

How did you hear about me?

Google Search

Online Directory (Psychology Today)

I was referred by a healthcare provider

I was referred by a friend/family member

Other (please specify)

How Can I Support You? (Check all that apply)

Individual Counseling

Couples Counseling

Individual Recovery for Sex & Porn Addiction

EMDR/Trauma

Not Sure Yet

Partner's name

Partner's Email address

Partner's Phone Number

Where are you located? (I am only currently licensed in Texas and Louisiana)

Texas Louisiana

What Type of Appointment Works Best for You?

Virtual (Zoom) Appointments I prefer in-person, but am okay with virtual as well In-Person only

My office space is currently in Lake Charles, LA.

Will you be using insurance or paying out of pocket? Please note: I can only accept Blue Cross Blue Shield for Louisiana residents. If you have an out-of-state BCBS plan, you may still be able to use your insurance, but we will need to discuss this. Also, I cannot bill insurance for couples therapy. If you have concerns about payment or insurance coverage, let me know, and we can talk through your options.

Yes, I have Blue Cross Blue Shield and live in Louisiana No, I plan to pay out of pocket I need to talk to you about this I plan on submitting my receipts to insurance for reimbursement

I typically recommend starting with weekly sessions and then tapering off to every 2 weeks, then monthly. Are you able to commit to this at this time?

Yes No

When is your preferred session time? Please note: My 4pm and 5pm slots are often booked weeks in advance. If your schedule is flexible, mark all the times you’re available.

Morning (8am-12pm)

Early Afternoon (12pm to 3pm)

Late Afternoon (3pm-5pm)

What are your goals for counseling?

Do you have any other concerns or comments?

I approve Woods Counseling Services to contact me via text on the phone number provided.

Yes No

Would you like to be added to my waitlist if no new client appointments are available? If my schedule is full, I can reach out if a spot opens up.

Yes No

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Ready to Get Started? Let’s Connect

Brent Woods, MA, LPC, CSAT

Licensed Professional Counselor