Long Island Institute of Sex Therapy (LIIST)

Forms

After scheduling your first appointment, you may fill out the following forms before the first session.  Please print them, fill them out, and bring them with you to the first session. Copies will be available to you if you forget or prefer to fill them out in the first session.

For couples, please have each individual complete a separate form.

Initial Form


Please only fill this out for minor’s attending therapy.

Permission to Treat a Minor

Please only fill this out if you would like to coordinate treatment with other professionals or family members.

Release of Information

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