Request An Appointment

Thank you for your interest in becoming a patient at Ziks Health Services. To ensure that you receive the best possible care, please complete this secure online self-referral form. We will review this information and then contact you by phone to schedule.

Ziks Health Services does not offer crisis mental health services. If you are experiencing a crisis (new or worsening suicidal thoughts, violent thoughts or impulses, or serious medical problems related to your mental health), please contact 24 Crisis Line: 214-828-1000/1-866-672-5100 or go to the nearest ER for urgent assistance.

The wait for new patient appointments is approximately 6-8 weeks with no urgent appointments available. Due to the high volume of requests, we may not be able to offer appointments to all interested patients. We will let you know as soon as possible if we are able to offer you an appointment.








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Payment Information





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We do not accept patients with coverage through Medicaid at this time.

Reason For Visit



Attention/ADHDDepressionBipolarPTSDGriefAnxietyPanic AttacksSocial AnxietyObsessions or Compulsions /OCDPhobiasAgoraphobiaInsomniaNightmaresBorderline Personality DisorderPersonality DisorderEating DisorderParanoiaHallucinationsDelusions (false beliefs)Schizophrenia / SchizoaffectiveDrug Addiction (in recovery or wanting to quit)Drug Addiction (currently using)Alcohol Abuse (in recovery or wanting to quit)Alcohol Abuse (still drinking)Victim of ViolenceVictim of Sexual AbuseExtreme StressRecent Traumatic ExperieinceChronic/Severe IllnessChronic PainChronic FatigueSexual IssuesMarital ConcensParenting IssuesWork-Related IssuesGender Dysphoria or Transgender IssuesCurrently PregnantPlanning to Become PregnantPostpartum IssuesPremenstrual or Menopause IssuesDevelopmental DelayAutismBrain Injury or DementiaLegal ProblemsAnger ProblemsViolent Thoughts or BehaviorSuicidal ThoughtsSelf Harm (cutting, burning, etc)Suicide Attempt in Last YearPsychiatric Hospitalization in Last Year (involuntary)Psychiatric hospitalization in Last Year (voluntary)










Practice Details

I have a primary care provider and have been seen in the last two years.
I understand the no-show / late cancelation fee.
I understand.
I understand.

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