Counseling Services Direct For Marriage and Family Therapy                             Long Island (516) 484-2829 Westchester (914) 960-2723

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Stacey Chernin
(516) 484-2829
info@counselingservicesdirect.com
Helpful Forms

If you're a new client of Counseling Services Direct, please complete the following forms and bring them to your first therapy session.

  • Client Psychotherapy Intake Form
  • Limits of Confidentiality/Therapy Cancellation Policy

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

  • Authorization to Disclose Information Form

Client Psychotherapy Intake Form  
Limits of Confidentiality/Therapy Cancellation Policy  
Authorization to Disclose Information Form  

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