Documents & Forms

Please note that all of our patient records are securely entered via a secure, dedicated internet “portal.”  When you call to arrange an initial appointment, our staff will guide you to create and access your records via the internet. Call 212.658.0110, ext. 122 or click here for more information about starting treatment with us.

Here are a few forms you may want to access throughout our process to help us track your child or student’s progress:

Selective Mutism Questionnaires to be completed by Parents or Teachers or Both

Vanderbilt ADHD and Disruptive Behaviors forms to be completed by Parents or Teachers or Both

After downloading any of these documents, and completing them, please either return them by mail to Kurtz Psychology Consulting PC, 57 W 57 # 1007, NYC, NY 10019-2802 or scan and send as attachment to info@kpcpc.com. You may also fax to us at 646.219.4619.

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