The Feeling Good Center
Secure Documents Form
To send us documents (e.g. recent paystubs), please complete this form. When sending photos of documents, you may find it easiest to complete this form on your smart phone. You may call us at (914) 533-4950 with any questions.
Are you applying for our sliding scale? *
What is your marital status? *
What is your living status? *
What are your monthly housing expenses? *
 Amount ($)
Rent
Mortgage
What is your work status? *
 +
Do you own any assets such a savings, real estate, stocks / funds (excluding retirement funds) with a value greater than $25,000? *
Please choose between one and ten document files to send us at once.
Please choose between one and ten document files containing your most recent three months of paystubs and / or bank statements.

Please describe the content of your document(s) in a few sentences.
0/250 characters
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Feeling Good Psychotherapy LCSW PLLC
235 Main Street • Suite 520 • White Plains, NY 10601
380 Lexington Avenue • 17th Floor • New York, NY 10168
160 Broadway • Suite 1204 • New York, NY 10038
feelinggoodcenter.com
(914) 533-4950