Request an Appointment

Please complete this form to request an appointment with Dr. Amy Fuller, LMFT, LPC or call (832) 848-0870.

Preferred Date and Time

Dr. Fuller sees patients from 8 to 4 Monday-Friday. If these hours will not work for your schedule please select referral request

Curious if your health care plan will cover counseling? Therapy is covered by most health insurance plans. To find out what the insurance will cover prior to the first appointment, please complete the information below regarding your insurance plan. Dr. Fuller will get back to you within 3 business days to let you know what the coverage will be for out-of-network mental health care. Dr. Fuller will discuss the coverage before sending in a claim to the insurance company.

Insurance Verification Information

Please provide any additional information. If you have another insurance through a spouse or family member please submit a separate form.

By submitting this HIPPA Compliant Secure Form, I am giving permission to Dr. Amy Fuller and her office staff to contact me or those listed above with the information provided. I am aware that email, telephone and text are not secure, private methods of communication.
YOUR PRIVATE HEALTH INFORMATION WILL BE KEPT COMPLETELY CONFIDENTIAL. Any insurance information provided will be for the sole purpose of determining eligibility of benefits for therapy.

Appointment Reminders:

An email reminder is sent to all clients 24-48 hours prior to an appointment from

The phone provided at the top of this form will be used for appointment reminders. If you prefer a different phone be used please list it here:

*Online Scheduling:

Dr. Fuller has online scheduling for current patients. Please enter a username and password to use for online scheduling: