Rita Carol Barsky, Ph D, CASAC

Contact Me

Request information on:
What type of counseling are you interested in?	Individual Counseling Group Therapy Couples Therapy Family Counseling Intervention
Please enter any details you think I should know about you.
Contact information:
First name:
Last name:
Date of birth
Gender
Email address:
Mailing address:
Daytime phone number:
Evening phone number:
Best way to contact you:	Email address Phone number Mailing address
Best time to contact you:
How did you learn about me?	Browsing the web Referral from another patient My blog, "A Sober Mind" Professional association Other
Additional information: (optional)
List any previous psychiatric or psychological treatment you've received, including dates
Current medications: