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Day Break Counseling Services, LCSW, PLLC

Providing Office and Telehealth Counseling
Connect with us...

 lisamaleklcsw@gmail.com
  PO Box 14903, Rochester, NY 14614
 585-732-8829
 585-385-4293


Forms

Intake Form

Counseling Intake Form

Consent Forms

Informed Consent For Telemedicine Services
Telehealth Emergency Plan
Credit Card Authorization Form
Excellus Authorization Form

Informational

Healthy Living Questionaire
Journaling After Counseling Sessions
Therapy Goals