Begin the Intake Process - Embrace Therapy LLC

Begin Our Intake Process

Thank you for connecting with us at Embrace Therapy. If you are interested in seeking treatment with us. Please complete the information below so we can begin the intake process. Once we receive your information, you will be contacted to complete a clinical consultation and match you with the therapist that will best meet your needs. NOTE: If this is an Emergency, please call 911 or the National Suicide Prevention Lifeline at 1800-274-8255 if you need an immediate response. Please do not rely on the communication through this contact form for urgent medical/mental health needs.

Name*
First Last
Date of Birth*
Month
Day
Year
Cell Phone
Phone
Email*
Insurance Name
Insurance ID #
Primary Policyholder if different
First Last
Date of Birth of Policyholder, if different
Month
Day
Year
Brief description of symptoms, concerns, or thoughts needing therapy?*
We’re back in the office as of July 5, scheduling in-person sessions. Can we meet at one of our offices?
- Yes
- No
Telehealth is still an option, on a limited basis.
Which location is best for you?
- Campbell Hall (Orange County)
- Croton-on-Hudson ( Westchester County)
- Bronx (Bronx County)
What time is best for you?
- Day
- Mid-Afternoon
- Evening

Begin Our Intake Process

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