PO Box 533, Shrub Oak, NY 10588

Phone: 845-282-3367

Gregory I. Mack, Ph.D. :

Clinical, Police, & Forensic Psychological Services PLLC

Comprehensive Intake Form

Psychotherapy Note 

Health Screen

Military Assessment

Military Assessment Significant Other

Substance Abuse/Addictive Behaviors Assessment

Relapse Prevention Plan


Crisis Intervention

Medications List

Treatment Plan

Treatment Plan Update/Revision

Discharge Plan

Patient Safety Plan

Preadmission Decision

Authorization For Release Of Protected Health Information Pursuant To HIPPA

Therapy agreement

ValueOptions Authorization to Exchange PHI







GREGORY I. MACK, PH.D.:CLINICAL, POLICE, & FORENSIC PSYCHOLOGICAL SERVICES PLLC is a Professional Limited Liability Company registered with the New York State Department of State. 

National Provider Identifier available @ HIPAAspace site

Mailing Address: PO Box 533, Shrub Oak, NY 10588

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