Request a Therapist Referral

This form will be transmitted directly to a PSI therapist by email. Please use it only to arrange a contact; do not write any confidential information here. You may speak confidentially to a PSI therapist when you are contacted by telephone.

We cannot provide counseling by email or telephone, but email or telephone contact is welcome to initiate a face-to-face appointment.

Please be sure you have filled in the form so we will be able to contact you. We do not collect any personal information other than what you provide on the form. The information will only be used by a PSI therapist to respond to your request; it will not be shared with anyone else.

If you aren’t ready to arrange an appointment, and just want to ask a question about therapy, counseling and spirituality, call our administrative offices at (212) 285-0043.

Request a Therapist Referral

I am contacting PSI because: *

I want to make an appointment.

I want to arrange an appointment for my child or teenager.

I want to speak with a therapist to find out whether psychotherapy or counseling would benefit me.

I am an executive or employer, and I want to know more about executive coaching, career counseling and/or organization staff development programs.

I want PSI staff to offer consultation to my faith community.

I am interested in: *

Individual therapy

Group Therapy or Workshop Groups

Couples/Relationship/Marriage Counseling

Workshops and Seminars

Mediation

Career Counseling and Coaching

Organization and Staff Development

Recovery Programs

Training in Pastoral Counseling and Psychotherapy

I live or work in the New York City area: *

Yes

No

Your Full Name: *

Your Email Address: *

Your Phone Number:

Best Time to Call:

May we leave a message at this number?

Yes

No

How did you hear about us?

Comments:

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