Contact

Phone:

(646) 535-3595

Email:

iva@balanceyourselfpsychotherapy.com

Mailing Address:

340 West 42nd Street
P.O. Box 2558
New York, NY 10036

Name

First Name

Last Name

Telephone Number

Do you live in New York or New Jersey?

What is your primary reason for seeking therapy?

Are you currently working with a therapist or psychiatrist? Please specify.

What are all of the times that you are available for therapy (generally 45-50 min/week)? Please be as specific as possible.

How did you find me?