Right to Receive a Good Faith Estimate of Expected Charges
Secure Scheduling Form
Please complete this multi-page form to schedule your first session.
Your First Name
Your Last Name
Your Email Address
Your Phone Number
Please acknowledge that emails and text messages should not contain sensitive information.
I understand that emails and text messages are inherently insecure, could possibly be read by third parties, and should not contain sensitive information.
Which days of the week are most convenient for sessions?
Which times of day are most convenient for sessions?
7:00 AM to 9:00 AM
9:00 AM to 11:00 AM
11:00 AM to 1:00 PM
1:00 PM to 3:00 PM
3:00 PM to 5:00 PM
5:00 PM to 7:00 PM
7:00 PM to 9:00 PM
Which locations / formats are most convenient for sessions?
New York Office
Video / internet
Which state will you be physically located in for video / internet sessions?
District of Columbia
What type of therapy are you seeking?
Would you like to be matched with a therapist?
Yes, I would like to be matched with a therapist
No, I have a specific therapist in mind already
Which therapist would you ideally like to schedule a session with?
Sarah Anas, Clinical Extern
Stephen Boegehold, Intern Therapist
Dora Bowman, LCSW
Crystal Chen, Clinical Extern
Kira Clark, Intern Therapist
Kimberly Collins, Clinical Extern
Emily Farr, LMSW
Foula Gavrilis, PhD, MHC, JD
Rina Goldstein, LMSW
Ellen Abrams King, LMSW
Racheli Miller, PhD
Kevin Montiel, LMSW
Leanne Sinsky, Social Work Intern
Do you have any form of medical insurance (including Medicaid or Medicare)?
No or don't know
Do you plan to pay for your sessions at least partially with insurance?
No or don't know
What is your date of birth?
Did you already provide your insurance information using our
insurance card form
Yes, I already provided my insurance information
No, I did not already provide my insurance information
What is the name of your employer?
THE COMPASSION PRACTICE
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