• MPG Service Inquiry Form

    We are excited to hear of your interest in services from our team of expert clinicians. Please complete the following form to the best of your ability.

    * indicates required question

  • About You

    The person completing this form
  • Format: (000) 000-0000.

  • A note on fees and insurance: Manhattan Psychology Group is a private pay, out-of-network practice — we do not accept insurance directly. Payment is due at the time of service, and we're happy to provide a superbill so you can submit for reimbursement if you have out-of-network benefits. Our fees range from $200 to $600 per hour depending on provider and service type. Click here to learn more about fees and payment.

    If you're seeking services funded through the NYC DOE, an RSA, or an Impartial Hearing Order, there is typically no out-of-pocket cost to you — please still complete this form so our team can follow up and guide you through next steps.

    If anything about fees, insurance, CPT codes, or our policies as an out-of-network practice is unclear, our Frequently Asked Questions page covers most common questions, or you're welcome to call us at (646) 389-4112 or email intake@manhattanpsychologygroup.com — our team is happy to walk you through

  • More About Yourself

    The person receiving services

  • About the Client

    The person receiving services
  • Date of birth of client seeking services*
     - -

  • Review our available services HERE

  • Insurance and fees

    Manhattan Psychology Group is a private pay, out of network practice, which we
    do not accept any form of insurance. Clients pay at the time of service and may
    submit a superbill to their insurance for possible reimbursement if they have out
    of network benefits.


    Our fees range from $200 to $600 per hour depending on the provider and service
    type. Please click here to learn more.


    If you are seeking services funded through the NYC DOE, an RSA, or an Impartial
    Hearing Order, there is typically no out of pocket cost to you. Please still complete
    this form so our team can follow up and guide you through next steps.
    If you are unsure which option applies to your situation or the fee information
    feels confusing, please call our main line at (646) 389-4112 or email our general
    intake inbox at intake@manhattanpsychologygroup.com

  • Multiple Services

    You indicated interest in multiple services or were unsure of the exact service needed. Pleasetake a moment to answer the questions that best apply to your situation. The moreinformation you share, the better we can assist you and streamline the process of gettingstarted with the appropriate services.

  • Mental Health Services

    You indicated interest in Mental Health services. Please answer the questions below so wecan provide you with detailed information about our services, clinicians, and the next steps toget you started as soon as possible.
  • Preferred location(s) for the client to receive services
  • Preferred appointment day(s) for the client to receive services
  • Preferred appointment time(s) for the client to receive services
  • Which Mental Health services are you interested in?*

  • Testing Services

    You indicated interest in Testing services. Please answer the questions below so we canprovide you with detailed information about our services, clinicians, and the next steps to getyou started as soon as possible.
  • What type of evaluation are you seeking?*

  • ABA Services

    You indicated interest in our applied behavioral analytic and educational services. Pleaseanswer the questions below so we can provide you with detailed information about ourservices, clinicians, and the next steps to get you started as soon as possible.
  • Which ABA services are you interested in?*
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