test

Welcome to Specialty Austin!

Please fill in the form below to request an appointment. Once received, a member from our team will reach out to confirm your appointment and next steps in 1-2 business days.
Specialty Clinic of Austin offers in-person and telehealth (video) appointments. Our team will verify your insurance before the appointment and inform you of any copay or deductible. We look forward to helping you.

Legal First name*

Legal Last name*

Mobile*

Email address*

Gender at birth*

Referred by*

City*

State*

In Person visit

Park Bend Medical Plaza
2217 Park Bend Dr, Suite 300
Austin, TX 78758

Telehealth Visit

Connect with one of our providers from the comfort of your home.

Name of person completing form and relationship to patient*

If the patient is a minor, please list the parents’ marital status:

Do you have any current or pending legal issues or are being advised by a court judge,parole officer, or CPS to seek mental health care or assessment?*
YesNo

Please select if you have ever experienced or suffered from any of the following in the past or present? (check one or all that applies)

Would you be interested in learning more and participating in any of our current or future clinical research studies?*
YesNo

Insurance provider*

Insurance ID #*

Group #(if applicable)

Please upload a picture of the front and back of your insurance card.

Welcome to Specialty Austin!

Preferred Appointment

In Person visit

Telehealth Visit

Our Location

About

Specialized Treatments

Our Brands

Support