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.
 
You may call us at (914) 533-4950 with any questions.
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.
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Your Marital Status *
 
Emergency Contact's Relationship to You *
 
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Feeling Good Psychotherapy LCSW PLLC
235 Main Street • Suite 520 • White Plains, NY 10601
feelinggoodcenter.com(914) 533-4950