The information you provide in this intake form is collected solely for the purpose of assisting you in being matched with an independent counselor from our network of licensed therapy professionals. Each counselor is a separate business entity and is solely responsible for their own practice.

Use and Retention of Information

• Your information will be used only to facilitate the counselor-matching process.
• We do not sell, lease, or distribute your personal information to third parties for marketing or commercial purposes.
• Once you are successfully matched, your information will only be shared with the counselor you have selected to enable initial contact.
• We do not retain your personal information beyond what is necessary to complete the matching process or as required by applicable law.

No Therapeutic relationship created

Submission of this form does not create or establish a counselor-client or therapeutic relationship. A professional counseling relationship begins only if and when you directly engage with, and formally enter into an agreement for services with, the independent counselor of your choice.

Privacy and confidentiality

We take commercially reasonable steps to protect your information during the matching process. However, please note:

• This form and matching service are separate from any confidentiality protections that will apply once you begin counseling.
• Electronic communications (including online forms and email) carry inherent security risks.
• Once you select and begin services with a counselor, privacy and confidentiality will be governed solely by that counselor’s own professional policies and applicable laws, including the Texas Behavioral Health Executive Council regulations.

You have the right to at any time to withdraw from the matching process at any time prior to engagement with a counselor. You can contact us at christylccc@gmail.com to have your data destroyed and removed from the matching process.

If you have questions regarding this disclaimer or how your information is handled, please contact us at:

Counseling Collective of Sunnyvale, 129 N. Collins Rd., Suite 2206, Sunnyvale, TX 75182. (972) 807-2222

By submitting this form, you acknowledge that you have read, understood, and agree to the terms of this disclaimer.