Get Started Now – Rosheen Haumann Counseling

If you are in crisis or need immediate help, please call 911 or go to your nearest emergency room. You can also contact the National Suicide Prevention Lifeline at 1-800-273-8255.

If you prefer to reach out to Rosheen directly by telephone, call her at 817-618-3849. Please Note: Rosheen handles her own calls and is often in-session with clients, so please leave her a detailed message. Also, she can reply faster via Text message so be sure to state in your message if it is ok for her to respond via text.

Completing the form below helps Rosheen by providing more information so she is better prepared when she reaches out to you.

Personal Information

First Name

Last Name

Street Address

City

State/Province

ZIP / Postal Code

Email Address

Phone

Are you planning to use insurance?YesNo

Insurance Provider

Insurance Phone NumberOn back of card, should say Provider Number or Mental Health Number

Member ID Number

Group ID

Do you know your CoPay for Mental Health Visits?

Is there anything you would like Rosheen to know before starting?

** Important Notice About Privacy and Security **

Please be aware that this form is not encrypted, and the information you provide may not be secure. While we take reasonable precautions to protect your privacy, electronic communications cannot guarantee confidentiality.

Do not submit sensitive personal health information or any information that you consider confidential through this form.

If you are in crisis or require immediate assistance, please do not use this form. Instead, call 911 or contact a local crisis hotline.

By submitting this form, you acknowledge and accept these terms.