My office is located in midtown Manhattan:
185 Madison Avenue
(between 34th and 35th Streets)
#15-07 (15th Floor)
New York, NY 10016
Subway: 6 to 33rd St. station, B, D, F, M, N, Q, R to Herald Square/34th St.
Nearby parking garage: Icon Parking Systems, 9 Park Ave. (34/35th Sts)
Call or email me to schedule an appointment or consultation:
Telephone: (917) 704-3761
Email: jacobethansmall@yahoo.com
Before We Meet
I ask that new clients review and complete forms before our first meeting. These forms will be provided when you arrive for your first consultation. Alternatively, for your convenience, I have provided some of these documents for you to download, if you wish to complete them in advance of our meeting.
Treatment Agreement
This document addresses a number of issues including agreements we make entering into a professional mental health relationship, my business policies, confidentiality, and your rights as a patient. [Download TreatmentAgreement]
Private Practice Intake Questionnaire (PPIQ)
The PPIQ is a self-report questionnaire I designed to assess a broad range of issues relevant to mental health. The PPIQ is reviewed by me and used to help me focus my inquiries on important information that you provide, to be reviewed in our assessment session. [Download PPIQ]