Appointments - Brooklyn Counseling Services

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Appointments

Founder & CEO

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Counseling Services

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Locations

Bay Ridge

Brooklyn Heights

Bensonhurst

32 Court Street – Downtown Brooklyn

200 Livingston Street – Downtown Brooklyn

Dyker Heights

East New York

Flatbush

Staten Island

Avenue X – Sheepshead Bay

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Appointments

Please fill in the form below to schedule an appointment. We will get back to you within 1 business day (Monday if you submit on the weekend).

If you are human, leave this field blank.
Location: *
Bay Ridge
Bensonhurst
Brooklyn Heights
Dyker Heights
32 Court Street - Downtown Brooklyn
200 Livingston Street - Downtown Brooklyn
East New York
Flatbush
Staten Island
Online (e-Counseling)
Avenue X - Sheepshead Bay

YOUR DETAILS:
Please fill in your personal and contact details

Full Name: *
For billing/insurance purposes, we must have your legal name exactly as it appears on your insurance ID Card
Phone *
Email *
Date of Birth
Address
Apt, suite, etc.
Country
City
State
Zip code
Gender (optional)
Female
Male
Are you a new patient? *
YES
NO
Please specify the best time to contact you:
morning
afternoon
evening
anytime
May we leave a message *
YES
NO

INSURANCE DETAILS:
State N/A if you do not have insurance

Insurance Provider: *
Insurance Plan: *
Insurance Number: *
Insured/subscribers name: *
Relationship to insured *
Date of Birth of Insured *

ARE WE RIGHT FOR YOU:
Are you employed?
YES
NO
Are you on psychiatric medication?
YES
NO
If yes, what medications are you currently taking?
Do you have any history of drug or alcohol abuse?
YES
NO
Have you been previously psychiatrically hospitalized?
YES
NO
Are you presently suicidal?
YES
NO
Do you think of hurting yourself?
YES
NO

APPOINTMENT PREFERENCE:
Please let us know your preferences for your appointment below.

Appointment Day: *
Please check 'all' days you are available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
or First Available
Appointment time: *
AM
PM
or First Available
Reason for your Appointment? ie. Depression, Family conflict etc
This question is optional and confidential. It will help us connect you with the therapist most suited to your needs.
*
I agree to the BCS Group terms and conditions. BCS Group will not share your information with any 3rd party entities.

ARE YOU HAVING SUICIDAL THOUGHTS?

If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7 across the United States.

National Suicide Prevention Lifeline

1-800-273-8255

LIVE CHAT: click here

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