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LETTER TO CURRENT CLIENTS

Dear Clients,


Out of an abundance of caution and our strong commitment to meeting the needs of our clients (inclusive of your safety and ours), we will continue to provide alternative counseling formats where appropriate (via Telehealth) to alleviate the need for in-person contact.  


Additionally, for our current clients, we will need updated Authorization and Communication Forms - please see below.


Thanks so much. We look forward to 'seeing' you soon!


Best regards,


Penny Siegmann, LCSW-R 

Owner

Counseling Services of Long Island, LCSW PC


2021 FORMS (for Current Clients) - ADULTS

Please 

Review, Sign & Return: 

via Confidential Fax (516-804-0448), 

Mail (54 Chicago Ave, Massapequa NY 11758), 

or Drop-Off to the Massapequa office. 

(If drop-off, please put in a sealed envelope, and leave in the mailbox, or place envelope in a bag hang 

on the inside of the front house door.)


2021 

AUTHORIZATION FORM -  ADULTS

Click Here


2021 FORMS (for Current Clients) - CHILDREN (< 18 years old)

Please 

Review, Sign & Return: 

via Confidential Fax (516-804-0448), 

Mail (54 Chicago Ave, Massapequa NY 11758), 

or Drop-Off to the Massapequa office. 

(If drop-off, please put in a sealed envelope, and leave in the mailbox, or place envelope in a bag hang 

on the inside of the front house door.)


2021 

AUTHORIZATION FORM -  CHILDREN

Click Here


PAYMENT OPTIONS FOR TELEHEALTH

For your convenience, we've streamlined session fee/copayment options

to include the use of the following services...


IvyPay 

(Credit Card/HSA/FSA):

​www.TalkToIvy.com


Ivy Pay is a smart phone-based payment system designed to be used with your credit card, HSA or FSA card. Stays on file for future payments. Free and easy.


("HIPAA-secure")



Zelle Pay

(ATM/Debit):

www.ZellePay.com

Code 5165286712

"Zelle is a free and easy way to send money directly between almost any U.S. bank accounts."


***This option is only for clients NOT using Health Insurance Plans***


("Not HIPAA Compliant")


Mail a Check:

You may mail a check to: 

54 Chicago Avenue

Massapequa, NY 11758