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To add a counselor, please complete this form. If you have any further questions you may contact:

Counseling Services
Dallas Theological Seminary
3909 Swiss Ave.
Dallas, TX 75204
1-800-DTS-WORD or 800-387-9673
General Information:
Full Name:    
Office Name (#1):  

Office Name (#2):

Web Site: http://
Academic Degree:  
License: #1   #2: #3:
License Number: #1   #2: #3:
Standard Fee:  
Insurance Accepted:
(separate with commas)
  • AARP
  • Aetna
  • American Family Insurance
  • American National Insurance Company
  • Amerigroup
  • Anthem Blue Cross and Blue Shield
  • Assurant
  • Blue Cross and Blue Shield Association
  • Centene Corporation
  • Cigna
  • Coventry Health Care
  • EmblemHealth
  • Fortis
  • Golden Rule Insurance Company
  • Group Health Cooperative
  • GHI
  • Health Net
  • HealthMarkets
  • HealthPartners
  • HealthSpring
  • Highmark
  • Humana
  • Independence Blue Cross
  • Kaiser Permanente
  • Kaleida Health
  • LifeWise Health Plan of Oregon
  • Medica
  • Medical Mutual of Ohio
  • Molina Healthcare
  • Premera Blue Cross
  • Principal Financial Group
  • The Regence Group
  • Shelter Insurance
  • State Farm
  • Thrivent Financial for Lutherans
  • UnitedHealth Group
  • Unitrin
  • Universal American Corporation
  • WellCare Health Plans
  • WellPoint
Languages Spoken:  
Specialty Information:
In which of the following areas do you feel especially qualified?

Specialized Techniques:
Age Groups:
Assessment Services:
Other Information:
Are you adequately covered by professional liability insurance?  

Briefly state your philosophy of counseling:
I attest that the information I have provided in this application regarding myself is accurate and truthful.