Cobb Psychotherapy LCSW
Secure Scheduling Form
To schedule your first session, please complete this multi-page form. For general inquiries, complete our general contact form. To request a benefits estimate, complete our insurance card form. You may call us at (718) 260-6042 with any questions.
You may find it easiest to complete this form on your smartphone as photos of your insurance card are required on a subsequent page, if you plan to pay at least partially with insurance.
How would you like us to communicate with you? *
Email Risk Acknowledgement & Use Consent *
Would you like to receive updates by email about new services?
Do you plan to pay for your sessions at least partially with insurance? *
Did you already provide your insurance information using our insurance card form*
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450 7TH AVENUE • SUITE 809 • NEW YORK, NY 10123
26 COURT STREET • SUITE 401 • BROOKLYN, NY 11242 260-6042