Client Forms

If you are new, please feel free to fill out these intake forms before our first session. These forms can also be filled out during the first session.

“I’m shedding off the old me and I’m reborn as the new me- it’s great!” – Brendon Urie

Client Intake Form

Information Sheet

Limits of Confidentiality

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information


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347 5th Avenue
New York, NY 10016
(646) 389-5298

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