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It’s easy to get started

Below you will find helpful links to download and fill out your new patient forms, then upload the completed documents and submit them below.

If you prefer to fill them out in person, we are happy to assist you during your first visit.

Please contact us if you have any questions or need assistance.

Consent Form

Download and fill out the Consent Form by clicking HERE.

Upload Insurance Card & Driver's License

Please scan and the front and back of your insurance card and the front of your driver’s license, then upload and submit within the form below.

Identification Form

Download and fill out the Identification Form HERE.

Have Questions?

We are happy to help! Please contact us at Nina@thespacebetweentherapy.com.

Submit Forms Here

If you would like to submit these documents online, please fill out the information below, upload the completed documents, then click submit.

If you would like to submit or update your symptoms, please click the button below and fill out the form.

Symptoms Form

    Securely Submit Your Consent and Identification Forms Here

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      Securely Submit Your Insurance Card (front and back) Here

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        Securely Submit Your Driver's License Here

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        Treatment

        • Couples and Partnerships
          • Marriage Counseling
        • Adult & Adolescent Counseling
        • Family Relations
        • Workplace Conflict
        • Telehealth

        Contact

        Licensed in Maryland and Texas

        6511 Stewart Rd, Suite 1C
        Galveston, TX 77551
        409.220.3067 | 443.398.1700
        443.279.2260
        nina@thespacebetweentherapy.com

        Let’s Get Started!

        • Telehealth
        • Identification Form
        • Consent Form
        • Payment

        Recent News

        • Our next All Relationship Group meeting will be held on Saturday, April 17 March 12, 2021
        • Our next Goodness Men’s Group will be held on Saturday, April 10 March 12, 2021
        • Our next Wonderful Women’s Group will be held Saturday, April 3 March 12, 2021
        • Our next Goodness Men’s Group will be held on March 13 February 12, 2021
        • Our next Wonderful Women’s Group will be held Saturday, March 6 February 12, 2021
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