Request an Appointment

Request An Appointment

Fill out the form below

Please fill out the information below or if you would like to talk to a team member please call us at 1-972-387-2824.

Once the form has been submitted, a Bliss team member will be reaching out regarding scheduling and next steps.

Patient’s Name(Required)

Parent Name (if applicable):

Email(Required)

Phone(Required)

Date of Birth(Required)

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Current Concerns(Required)

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Insurance Name(Required)

Insurance ID #(Required)

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