The Feeling Good Center
Secure Intake Form
Welcome to Feeling Good Psychotherapy!
Please only complete this multi-page form if we've asked you to. Otherwise, please first complete our scheduling form.
The information that you present here will serve as a basis to get to know you as well as serve you better. Information will be kept in the strictest of professional confidence.
How would you like us to communicate with you? *
Please enter the same email address that you entered on our scheduling form.
Email Risk Acknowledgement & Use Consent *
Please enter the same phone number that you entered on our scheduling form.
Your Marital Status *
Emergency Contact's Relationship to You *
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(914) 533-4950(212) 362-4490