📋 Understanding your sleep profile
Were you referred to us by your clinician?
A referral is not required to start treatment with our clinic
Who is your referring clinician?
This information ensures your care is correctly coordinated across your healthcare providers.
📋 Understanding your sleep profile
What sleep issues are you currently experiencing?
Difficulty falling asleep
Difficulty staying asleep
Waking up too early
Anxiety about not sleeping
📋 Understanding your sleep profile
How long have you had your sleep problems?
CBT-I is the recommended treatment for insomnia
Our clinicians specialize in CBT-I (cognitive behavioral therapy for insomnia), the #1 clinician-recommended sleep treatment program with proven results.
CBT-I retrains your brain to fall asleep faster and stay asleep longer.
Confirm you are in (or can be in) the state of New York
Just a heads-up: to receive treatment, you'll need to either live/work in New York or be able to be in New York for your appointment.
Even though our clinicians conduct telehealth video appointments, the law requires that you are physically located in New York.
What's your contact information?
Please enter a valid email address
Please enter a valid 10-digit phone number
Your information is kept private and is used for appointment booking purposes only.
Thank you! We'll reach out to you to schedule your first appointment.
If you submitted this form within our normal business hours, we'll aim to call you some time today to confirm your intake session.