For your protection, we need your consent for this services on the platform we link for you, so that you have a secure conversation with your counselor!

  • PLEASE ENTER TODAY'S DATE
    MM slash DD slash YYYY
  • I give my permission and consent to the East Texas Counselor to provide counseling services to my child/children:
    Name (First Name and Initial Last Name)AgeYour initial here to consent 

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