Ben Medley LMSW Psychotherapy for Individuals and Couples

  • Home
  • Services Provided
  • Common Questions
  • About Me
  • Rates & Insurance
  • LGBTQ
  • Helpful Forms
  • Contact Me
  • Privacy & Policy
  • Location
  • Links & Resources
Ben Medley
917-348-9505
1133 Broadway Suite 511
@26th Street
New York, NY 10010
ben@benmedleytherapy.com
Helpful Forms

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

  • Client Psychotherapy Intake Form

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  

 
Authorization to Disclose Information Form  

Note: To download Adobe Acrobat Reader for free, click here.


©2010 by TherapySites.com. All rights reserved.
edc957169c17410944058fec1e64fcb7