Intake Forms

Child & Adolescent Form

Please download the form and fill out.

Child/Adolescent Form


Adult Background Form

Please download the form and fill out.

Adult Form


The Psychological Health Collaborative PLLC
1025 Northern Blvd. suite 214
Roslyn, New York 11576
Phone: 516-466-2537
Fax: 516-439-4936
Copyright © ff The Psychological Health Collaborative, PLLC