Behavioral Health Direct - Therapy for Anxiety and OCD
Sign in to Google to save your progress. Learn more
Hi! Thank you for taking the time to complete this form. I am accepting new patients and look forward to speaking with you. 

Please leave your name, contact information, and a brief message. I will get in touch quickly. You can also go directly to scheduling or call and email me. 
-Yisrael Zev Schwartz, LCPC

To schedule and see my availability click here. To view and complete my intake form click here.
Name *
Phone Number *
Email *
Message *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of behavioralhealthdirect.com. Report Abuse