Get Forms

Click on the “download” link for each of the forms below, print, fill them out, and bring them with you to your first appointment.

Telehealth Information Sheet
Download [16.0 KB]

Telehealth Consent Form
Download [22.0 KB]

Client Information Form
This form can now be filled out digitally and emailed or printed. Download [1.0 MB]

Client Insurance Information/Receipt of Privacy Policy Acknowledgment
This form can now be partially filled out digitally. Download [2.0 MB]

Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Download [445 KB]

Contact Us
North Main Counseling 84 North Main Street Cortland, NY 13045 Phone: (607) 545-4532 gmoss@northmain-counseling.com

Certified in EMDR Therapy

If you are ready to take the next step towards having a richer and happier life…

Make An Appointment