Welcome
We are so glad you are here, and we look forward to learning how we can support you and your family or agency.
Please complete each section as best you can. If something does not apply, type N/A rather than leaving it blank. That helps us review your application faster and make sure we have everything we need.
Once you submit it, our team reviews it and reaches out with the next steps.
Call 911, or 988, or the Harris Center crisis line on 713-970-7000.
🧒About the child
If something does not apply, type N/A rather than leaving it blank.
🧑Parent or legal guardian
Who we should call, and how to reach them.
📝What has been happening
In your own words. There is no wrong way to answer this.
📬Who is referring
So we know who to call back.
✅What you are agreeing to
Tap a card to read it in full, then tick it. You may decline anything optional.
📱Text and email
Neither is fully private. A text sits unlocked on whatever phone it arrives on. Anything clinical goes to your secure portal instead. Saying no changes nothing.
✍️Sign once
Thank you,
Everything reached our intake team.
We reach out in 1-2 business days
We arrange next steps and agree a plan with you