Contact Grace Psychiatric Services, PLLCHolly Kerby MSN, APRN, PMHNP-BC2913 Williams Dr, Suite 220Georgetown, TX 78628 Tel: 512 868 3972Fax: 512 887 4201 info@gracepsychiatricservices.com You may also complete the form below and we will be in touch with you shortly. Name(Required) First Last Email(Required) Enter Email Confirm Email Phone(Required)Brief descriptions of services needed:(Required)Important Notices: 1) Privacy Advisory: Please refrain from disclosing any protected health information on this form. Such details will be discussed during a confidential phone consultation or initial evaluation 2) Good Faith Estimate: I am committed to providing a “good faith estimate” of anticipated charges for services upon request. This estimate will be provided before any services are rendered, ensuring transparency in our billing process. 3) Insurance Participation: At Grace Psychiatric Services, PLLC, we have chosen to operate independently from insurance panels, Medicaid, and Medicare. This decision reflets our dedication to placing the needs and preferences of our clients first, ensuring a personalized and confidential therapeutic experience. A ‘superbill’ will be provided upon request, for potential reimbursement purposes.To prove that you are human please spell out the answer to seven plus four. Once you do that you will be able to submit this form.(Required) NameThis field is for validation purposes and should be left unchanged.