Book Your Appointment At Abridged Psychology

If you need to speak to someone right now, the

National Crisis Line is always available by dialing 988.

If you are having a medical emergency, please call 911.

Please fill out the Form below.

Or if you prefer to CALL US, click the phone number above,

wait for the recording and leave a detailed message.

First Name *

Last Name *

Counseling / Service For *

Child
Tween/Teen
Young Adult
Adult
Testing
Groups
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Child's First & Last Name

Child's Age

Child's D.O.B.

Email *

Phone *

Address

Age

DOB (MM-DD-YYYY)

Insurance Coverage *

NONE (Private Pay)
LYRA
Cigna
Aetna
1199
Empire / NYSHIP
Emblem GHI / HIP
UHC / Oxford
Northwell Direct
Other
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Primary Insurance Holder DOB

Primary Insurance Holder First Name

Primary Insurance Holder Last Name

Member ID

Best time to contact me

In the Morning
In the Afternoon
In the Evening
Anytime
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Preferred Session Location:

In Our Office (In Person)
From My Home (Video Conference)
Both (Hybrid)
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Message

NOTE: Please have your INSURANCE DETAILS AND PAYMENT INFORMATION ready (we are a paperless fully electronic practice). Once your therapist session is booked you'll also need to login to our EMR system to accept standard documents.

CONSENT: By checking this box, I agree to share my form responses with Abridged Psychology.

Yes

DIRECTIONS: By checking this box I confirm that I have scrolled down BELOW for directions to our office using the BACK ENTRANCE to 65 Hilton Avenue - Suite 201.

Yes