Safe Haven

A safe place for healing.

Please complete at least 24 hours prior to your first appointment.

Counseling Intake Form

Personal Data Inventory Form

Spanish Counseling Intake Form

If you are coming in for an immigration appointment, please complete the following forms at least 24 hours prior to your first appointment.

Immigration Personal Data Inventory Form

Spanish Immigration Personal Data Inventory Form

Sliding Fee Scale is used for those clients who would prefer to pay out of pocket and/or their insurance does not cover behavioral health. If this is an option for you, please sign and return this form via Fax: (281) 605-6670 or email: [email protected] at least 24 hours prior to your first appointment.

Sliding Fee Scale

If you have an interest to volunteer with Safe Haven Refuge, please fill out this form and return via Fax: (281) 605-6670 or email: [email protected] We look forward to partnering with you. 

Volunteer Application