Lynne Moser, LCSW, LLC ~ 33 South Delaware Avenue, Yardley, Pennsylvania 19067

917.605.1006 call/text

917.605.1006 call/text

  • Home
  • Teens & Young Adults
  • Adults in Transition
  • Deaf & Hard of Hearing
  • Services
  • Credentials
  • Rates & Insurance
  • What's EMDR?
  • The No Surprises Act
  • Forms
  • More
    • Home
    • Teens & Young Adults
    • Adults in Transition
    • Deaf & Hard of Hearing
    • Services
    • Credentials
    • Rates & Insurance
    • What's EMDR?
    • The No Surprises Act
    • Forms
  • Home
  • Teens & Young Adults
  • Adults in Transition
  • Deaf & Hard of Hearing
  • Services
  • Credentials
  • Rates & Insurance
  • What's EMDR?
  • The No Surprises Act
  • Forms

INTAKE FORMS

Click on a file to download. Feel free to print/send only the pages that require your writing and signature.  *Required forms have asterisks.

*Intake & Demographics (pdf)

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Consent for Release of Information (pdf)

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*Credit Card Agreement (pdf)

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*Informed Consent & Policies (pdf)

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*Good Faith Estimate (pdf)

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*Notice of Privacy Practices (pdf)

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*EMDR Informed Consent (pdf)

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Copyright © 2025 The Empowerment Room LLC

 Psychotherapist

33 South Delaware Avenue

Yardley, PA 19067

917.605.1006 talk/text


Providing In-Person Therapy in Bucks County, PA

Providing Virtual Therapy to all of PA

  • Therapist in Yardley PA
  • Teenager Therapist
  • Therapy for Anxiety

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