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JFS Non-Emergency Therapist Request Form

Jewish Family Service’s clinical professionals are often requested to present/attend at programs that are sensitive in nature or may trigger emotional responses by the audience. We will do our best to accommodate such requests made of our therapist. In order for us to provide you with the most appropriate credentialed professional for your program, please complete this form and submit it at least two weeks prior to the date of the program to or fax at 713-667-3619. If you have a program flyer, please attach that as well. Please note, submission of this form does not indicate confirmation that a therapist will be present. Our counseling staff will contact you within a week of submitting this request form. Thank you!

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