ContactRicardo@ArchetypePsychotherapy.com(956) 292-19793701 Sanguinet St, Ste 102Fort Worth, TX 76107 Name * First Name Last Name Date of Birth * MM DD YYYY Email * Phone * (###) ### #### Insurance (if applicable) Brief Description of Issue(s) * Thank you. Please allow 24 - 48 hours to respond. Once I receive your submission I’ll send you the intake forms via e-mail. After the intake forms are completed you will have access to a client portal where you can schedule online.