DBT (Dialectical Behavior Therapy) Interest Form

Thank you for your interest in the PM Pediatric Care DBT Skills Group for Adolescents (ages 13-17).

Complete the form below and a team member will be in touch as soon as possible to discuss your needs.

Email Address *

Patient Name *

PatientDateOfBirth *

Name of Person Completing this Form

Relationship to Patient

Phone *

State *

We’re proud to accept Aetna, Fidelis Care, Healthfirst, and Point Comfort behavioral health insurance coverage in New York. We encourage you to check with your insurance provider regarding your coverage for group therapy.

If you are experiencing a life-threatening emergency, please follow the emergency plans provided by your therapist or doctor, or call 911 and go to the nearest Emergency Department.