(516) 835-2048

6800 Jericho Turnpike - Suite 120W
Syosset, New York 11791

Intake Packet

For your convenience, you may download, review, print out and sign the necessary intake forms prior to your visit with me.  Not all these forms will be required, depending on your particular needs.  If you're not sure if you need a form or not, please contact me to ask.  Don't worry if you don't fill out a form that you need.  All forms are available at the office.

Consent for Psychotherapy Services

HIPAA Notice of Privacy Practices

Authorization to Release Information

Client Information Form - Adult

Client Information Form - Child under 18

Credit Card Authorization Form

Telemedicine Informed Consent Form