DBT Outside Therapy Form

  • DBT Outside Therapy Form
    NYC PSYCHOLOGY INC., PC
    Manhattan | Brooklyn | Rockland County | Great Neck
    646-837-5557 | info@centerforanxiety.org

     

    THIS FORM IS TO BE COMPLETED BY ALL DBT SKILLS GROUP PATIENTS WHO ARE RECEIVING INDIVIDUAL THERAPY FROM OUTSIDE OF OUR PRACTICE.

    I, the undersigned, understand that I am coming to NYC Psychology,PC only for a Dialectical-Behavioral Therapy (DBT) Skills group and that I will be seeking individual therapy outside of the practice.
    The following person will be providing me with individual therapy:


    ALL FIELDS MUST BE COMPLETED IN FULL


  • NYC Psychology, PC has my authorization to provide a copy of this document to my therapist and also to communicate in any way that might be beneficial to my treatment. I understand that full-service DBT typically involves DBT skills groups, DBT-focused individual therapy, plus between-session support (crisis management, case management, coaching, etc.). I understand that I will not receive any individual therapy or between-session support from NYC Psychology, PC, and that I will not receive any other services aside from a weekly DBT Skills group. I understand that I may choose to seek individual therapy as well as the above services from NYC Psychology, PC at a later point, in which case I will contact the office to make appropriate arrangements.

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY

At A Glance

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9:00am - 9:00pm

Friday, 9:00am - 2:00pm

Telephone: 646-837-5557
Toll Free: 888-837-7473
Fax: 646-837-5495
info@centerforanxiety.org

The Center for Anxiety™ is a Limited Liability Company (LLC) that is owned and operated by David H. Rosmarin, Ph.D. The Center provides consultation in psychological research by designing, implementing and examining results from research protocols to help facilitate evaluation of treatment outcomes, and training for mental health professionals in evidence-based treatments for anxiety symptoms. All clinical services described on this website are provided by NYC Psychology Inc., a Professional Corporation (PC) that is also owned and operated by David H. Rosmarin, Ph.D.; Usage & Privacy Policy