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)

Download

Consent for Release of Information (pdf)

Download

*Credit Card Agreement (pdf)

Download

*Informed Consent & Policies (pdf)

Download

*Good Faith Estimate (pdf)

Download

*Notice of Privacy Practices (pdf)

Download

*EMDR Informed Consent (pdf)

Download

Copyright © 2025 Lynne Moser, LCSW, LLC

 Psychotherapist

33 South Delaware Avenue

Yardley, PA 19067

917.605.1006 talk/text

  • Therapist in Yardley PA

Powered by

This website uses cookies.

We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.

Accept