• My Services
  • Who I Help
    • Professionals and Executives
    • 18+ Students and Young Adults
    • Parents and Families
  • FAQ
  • Media
  • Blog
  • About
  • Contact
Book A Free Consultation

Forms

Practice Forms

  • Fill Out and Return.

HIPPA Notice of Privacy

    • Click to View.

HIPAA Release Form

    • If Asked, Please Print and Sign for Each Provider.  New Forms May Be Printed and Signed as Needed.
Find me on CAB-NYC
verified by psychology today
Zencare Therapist Badge
Featured on TherapyTribe
Anxiety & Depression Association of America
Psychologist Locator
Authority to Practice Interjurisdictional Telepsychology
Forms

Practical Solutions for Professionals in Business, Tech, Law, Healthcare, Education, Arts, Emerging Adults, and University Students.



Phone

(212) 933-0758



Email

drm@groundbreakertherapy.com



Address

30 Old Kings Highway South #1055
Darien, CT 06820

  • Follow
  • Follow
  • Follow
  • Follow
Forms
Copyright © 2014 - 2025 PSYSOED DYNAMICS LLC. All Rights Reserved | Designed by Priceless Consulting LLC