e mail therapy

516-764-2526

Marriage and Family Therapists of
New York

Payment is required in advance of consultation.

To Start

Before arranging a
consultation, please send
an E-mail to
atwood@optonline.net
stating that you would
like to begin e mail
therapy.

Office Location

542 Lakeview Avenue
Rockville Centre N.Y. 11570
516-764-2526

Your Name

Your E-Mail Address where we will reply to you

Your Phone Number in case we need to contact you
directly

Background Information to include:

		Date of birth
		Marital status and number of children with age
		Brief description of the issue you wish to discuss
		What you hope to gain as a result of our “talks?”
		What you have tried thus far to solve this issue?
		What else should I know about you?

Please do NOT send us any information about your
situation until arrangements have been made with your
consultant-therapist. We will try to respond to you within 24
hours. This response time might be slightly longer over
weekends.

To make a payment, please click on the Make A Payment
button below. The payment form will open up in a new
window. Enter your name as it appears on your card, along
with your billing address.

Complete the payment form,
including your payment amount
plus the 5% service charge
and click on the submit button.

Now we are ready to talk…

Make A Payment

For more information call or E-Mail us at
jatwood@optonline.net

E - Therapy

Information To Include

In addition, include the following information in your
initial message: