The forms on this page can be printed and completed by New York Behavioral Health clients who are receiving psychotherapy at our center.
They are to be returned to your treating clinician.
Please select only one Customer Contract Form (CCLC or CCSC) according to whether you will be seeing a licensed clinician or an unlicensed supervisee.
For persons under 18 years there are special CCLC-u18 and CCSC-u18 forms.
In both cases, the current rate needs to be filled in with a pen prior to signing.
- Customer contract (licensed clinician)
- Customer contract (supervised clinician)
- Customer contract under 18 (licensed clinician)
- Customer contract under 18 (supervised clinician)
Insurance Information Form for Therapy Provided
Contract for Out-of-Network Insurance for Therapy
There are times when a client may request that his or her CBT therapist collaborate with other professionals treating the psychotherapy client or speak to family members or loved ones. When that is the case the form below can be used.