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Request an Appointment

with a Graduate Intern

At NLCC, we are interested in trying to connect you with the therapist best suited for your needs.  Thus, even from the first phone call, we believe that a good investment of time for both you and your therapist is to spend approximately five minutes on the phone to gather an idea of what issue(s) may invite you to seek counseling.  And based on this information, your therapist may offer you a referral to another therapist, who may specialize in something that you seek, or offer to set an appointment. All of our Graduate Interns work exclusively at our Round Rock location.


These forms are listed here for our first-time visitors who are seeing one of our Graduate Student Interns. Please print at home and fill out ahead of your appointment. 


Individuals & Couples:  Please read #1, and print and fill out #2 and #3 before your first appointment. 

1. HIPAA consent

2. Adult Personal Data

3. General Consent to Treatment 



Child-Adolescent Clients: Parents/legal guardians, please read #1, and print & fill out #2, 3 and 4 before your first appointment.

1. HIPAA consent

2. Adult Personal Data

3. Child & Adolescent Personal Data

4. General Consent to Treatment

Required paperwork for working with Interns: Choose which Intern you're working with and then download, read and sign before your first appointment.

Stephanie Ruyter

1. Grad Intern Informed Consent for clients

2. Grand Intern Consent

James Van Matre

1. Grad Intern Informed Consent for clients

2. Grand Intern Consent

Additional paperwork if needed:

1. Online therapy consent form

2. Release of Information

3. Sliding Scale Application


For a quicker response from our team, please fill out our online form. Phone calls will be returned in 24-48 hours.

Orange Couch
Do you have any current pending legal proceedings related to your counseling inquiry?If yes, please explain below:
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