Request a Consultation

Please complete the form below to request a consultation

A member of our team will review your information and contact you within one business day.

We answer all inquires so please check your spam folder if you don’t see a response.

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Patient*

Name of Parent/Guardian (if patient is a minor)

Patient's Date of Birth*

Contact's Email Address*

Patient Location
IMPORTANT - If you are located in the U.S., but not in the one of the states below, we cannot provide treatment

What Best Describes Your Treatment Needs?*

Please limit questions to administrative matters. If you have multiple questions, please opt for a consultation.

How did you hear about us?

Referral from An Other Practice
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IOCDF
The Tourette Association
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Other

If other, please specify

By submitting this form and the information within, you acknowledge and agree that this information is accurate and you are only submitting on behalf of yourself or your legal dependent. By providing your phone number and email address, you allow Beyond Borders CBT, LLC to contact you via phone and/or email to coordinate care and acknowledge that email is not a HIPAA compliant form of communication. Beyond Borders CBT, LLC will not sell, disclose, or otherwise use this information for any other reason than coordinating care directly with you.