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  • I hereby authorize NYC Psychology Inc., PC to release the information about my assessment and/or treatment to the following person(s) or facility(ies):

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  • I understand that I refuse to sign this authorization without affecting my eligibility for assessment and/or treatment. I further understand that I may withdraw this authorization at any time by submitting a written request to David H. Rosmarin PhD, 200 West 57th st, Suite 404, New York, NY 10019. Authorization may be withdrawn except to the extent that action has already been taken in reliance on this authorization. I further understand that information released on this authorization is no longer protected by NYC Psychology Inc., PC (e.g, if re-disclosed by recipient). To the extent to which my file contains information regarding alcohol and/or drug treatment (protected by Federal Regulations 42 CFR, Part 2) or HIV antibody/antigen testing (protected by NYS Law), I authorize disclosure of such information.

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Center for Anxiety™ LLC is a management services organization that provides administrative oversight and consulting services. All clinical services described on this website are provided by NYC Psychology PC (“NYCP”). NYCP is independently licensed to practice, psychology and psychotherapy.

           

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Telephone
Tri-State: 646-837-5557
Massachusetts: 617-675-1700
Fax: 646-837-5495
[email protected]

Our Team Contact Us
Careers Blog
About Us Our Offices
Getting Care Wellness in the
Workplace
Get Started FAQ

Center for Anxiety™ LLC is a management services organization that provides administrative oversight and consulting services. All clinical services described on this website are provided by NYC Psychology PC (“NYCP”) and Anxiety Psychiatry Medical PC (“APMP”). NYCP and APMP are independently licensed to practice, respectively, psychology and psychotherapy, and medicine and psychiatry. Each is exclusively responsible for its own professional practice and neither is responsible for the professional practice or actions of the other. There is no formal professional affiliation between NYCP and APMP. NYCP and APMP advertise together on this website for the sole purpose of jointly marketing and providing information about the complementary but unrelated services they offer.

This website is accessible to the blind as per ADA guidelines.

Subscribe to our newsletter.

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Copyright © 2021 Center for Anxiety. All Rights Reserved | Privacy Policy