Link below will take you to the page with Registration DIrections &

 Schedule for each group and Leadership Certificate Program.

Directions & Schedule

Parenting An Adolescent Lunch, Day and Evening Groups

Please mail back with

50.00 Deposit per person and preferences from schedule at this link


InspireAmindTM Counseling, Education & Business Consulting Solutions

100 Duffy Avenue Suite 510

Hicksville, NY, 11801 (516) 595-3092 Office

[email protected]

www.InspireAmind.net

~PARENTING GROUP REGISTRATION FORM~

GROUP DEMOGRAPHIC INFORMATION Please sign everything with an x

Parenting Group (Includes Any Guardian of Pre-teen/Teen):

BASIC INFORMATION -Options 1, 2

OPTION 1 LUNCH EXPRESS

How Many People Are You Registering 1  or  2 Please circle number (Max 2 a Form)

Mondays 1:00-1:45_____________________

Wednesdays 12:00-12:45 __________________

45 minutes 1 x week, holidays will be rescheduled

July    Mon     Wed                                                     August     Mon     Wed

If group would like to continue that is an option- Current program is 4 weeks.

FOOD ALLERGIES for light lunch and beverages during lunch hour ______________________? Will you be bringing food due to allergies? Is there an item that cannot be in the room (i.e. Peanuts)?


OPTION 2 Write # of people next 2 time- UP to 2 per form (related to Teen for Registration Form) (i.e. 1 =one person attending at the time slot next to the month) 1x week 45 min beverages avail.

July  Mon   Tues  Thurs                                      August Mon    Tues     Thurs

Daytime: Thursday 2:00-2:45____________________

Evening: Tuesday 5:00-5:45 ____________________

Wednesday 5:15pm-6:00pm____________________


Please print reg. Form attached to link and mail w 50. Per person ! 

Final Choice Day:___________ Time:__________________ Month: July_____August

From Selections Above

Please enclose a non - refundable 50.00 deposit for each participant to Marcy Abramsky, LCSW. I will confirm receipt of this and our July start date- please let me know of any conflicts you have in July- thank you. Remember if you sign up this week you qualify for the LOWER RATE! Thank you for your business!

___________________________________________________


Option: Do you think your child would come in for a free session after the completion of group to meet with us ________________________________?



InspireAmind Counseling, Education & Business Consulting Solutions

Owner, Marcy Abramsky, LCSW SIFI MST SBA SDA

100 Duffy Ave Suite # 510

Hicksville NY 11801

516-595-3092 *[email protected] *InspireAmind.net

Hours by Appointment Only




Objectives

o leadership and social entrepreneurship to environmental sustainabilityCreate connections between students’ passions and academic interests

o leadership and social entrepreneurship to environmental sustainabilityleadership and social entrepreneurship to environmental sustainability

oInspiration and preparation to bring change and be active, engaged civic leadersInspiration and preparation to bring change and be active, engaged civic leaders


Interactive discussions will accompany  lessons to provide students with a wide range of exposure to the many ways they can work together to create a positive impact in their own communities.

Participants will expand their social network of peers and gain supportive personal  mentors while acquiring an authentic understanding of a leadership  experience.

Junior  Monday/Wednesday 9am-10:30 2x week 90 min each snack beverage provided

Young Adult Leaders Tueday/Thursday 12-1:30pm 2x week 90 min each snack beverage provided

Please share allergies

questions? email [email protected]! Don't Delay!!! 

Transition To Middle School Groups

Registration by using link above with program name ! 

InspireAmindTM Counseling, Education & Business Consulting Solutions

100 Duffy Avenue Suite 510

Hicksville, NY, 11801 (516) 595-3092 Office

[email protected]

Small group transition counseling allows students with to strengthen their skills in the areas of personal/social, emotional, and academic  development. A small group setting, employs a strategy that assists pre-teens, in their comfort level ultimately giving them and environment in which they can meet with success. 

Sessions focus on student needs while, covering topics that are vital to their middle school

transition.  

A central theme carried through our sessions will focus on  development of awareness of interpersonal issues (increasing positive social interactions ,  strategies and skills to  school achievement and to increase appropriate social interaction skills.



ADULTS/- DO YOU NEED A *FREE 20 min CONSULTATION RE: Services for your child In MIDDLE SCHOOL?  Click the link! Schedule NOW, committee's meet all summer. There are MANY services your child may be entitled to under the law, even if your child ISN'T CLASSIFIED. BEFORE you start middle start middle school, BE IN THE KNOW.



 Please furnish us with a copy  ( we will return ) of any court orders in reference to your child. This will assist us in protecting your rights, your child’s safety and upholding the law. 

If you ever have someone else bring  the student,  to expedite the building security process. We will have a quick orientation email so you have all the info when you sign up! 

There is visitor parking right by the door,  to bring your child, to group. However, garage parking is always free for clients, with an appointment.



Topics Small Group Counseling Units and Sessions

 Students entering 6th grade Fall 2018 Middle School (6-8)  

     Concerns of Students in Group and As We Go Along Will be Addressed

Being A New Student at A School 

Coping with Life Changes

Personal &  Social Development  

Self Awareness/ Self Control/Anger Management

Tips That Only You Will Know :) 

     Study Skills / Who and Why to Get to Know Certain Adults

     Tips for how to answer a student or teacher in  ANY Situation

Enjoyment of This Exciting Change!


FOODPlease share allergies, as a  light snack & beverage will be provided (included). A soda /Iced Tea and Gatorade machine, is available in the suite for drinks to be purchased at $1.50. A snack vending machine is available on the 3rd floor should you choose to take your child there before or after. However, we will not be leaving the suite during our group session.

 

After completing Registration form attached to link on program name... 

Mail this Registration Form and Consent Forms with  a 50.00 non refundable deposit to hold a place for the _________________(time) group ,  on each ____________________ Day for 90 minutes, for 4 consecutive weeks during the month of  ___________________, unless there is a holiday (make-up) or ALL the participants agree to another makeup session, due to another reason.  See Directions and Registration Schedule for group. 

Checks made out to Marcy Abramsky, LCSW and sent to InspireAmind Counseling & Counseling 100 Duffy Ave Suite#510 Hicksville, NY 11801 Postmarked Before Friday 5/25/ 18 EXTENDED  early pricing!


**Refer to the Information page for the directions, mailing and scheduling at this link and the link at the top  Directions and Schedule

 

For All Student And Parent Groups 

BASIC RIGHTS & HIPPA Please Read & Sign

1. You have the right to impartial access to treatment regardless of race, religion, sex, age ethnicity, or handicap.

2. You have the right to considerate and respectful treatment and recognition of your personal dignity.

3. You have the right to a written statement of your rights.

4. You have the right to be informed of your rights.

5. You have the right to services provided in the least restrictive environment possible.

6. You have the right to participate in treatment decisions.

7. You have the right to obtain information about treatment recommendations and alternatives.

8. You have the right to implement services with clinicians for patients under 12 years of age (together) unless it creates harm

9. You have the right to periodic review of your treatment plan.

10. You have the right to be involved in planning termination of your treatment.

11. You may terminate services at any time unless legally prohibited from doing so- N/A to this practice

12. You have the right to be informed of alternatives available when you leave treatment, and you will be given specific follow-up recommendations outlined.

13. You have the right to report any incidences of abuse or neglect, whether you are a victim or an observer.

14. You have the right to expect that all communications and report records pertaining to your treatment will be treated as confidential, except as otherwise required by law.

15.Clients, significant others, and staff have the right to have ethical issues that arise in treatment considered.

16. You, your family, or legal guardians, have the right to present complaints concerning the quality of care received.

17. You have the right to withdraw your permission at any time in matters to which you have previously consented.

Client Signature ______________________________ Date __________________________

Parent or Representative Signature (relationship)______________________ Date __________

InspireAmind Counseling, Education & Business Consulting Solutions

Owner & Clinical Director, Marcy Abramsky, LCSW SIFI MST SBA SDA

100 Duffy Ave Suite # 510

Hicksville NY 11801 516-595-3092 *[email protected] *InspireAmind.net


HIPAA Notice of Privacy Practices

This Notice of Privacy Practices describes how we protect your information and the only circumstances under which we may be required to use it, as required by law. It also outlines your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.

I. Uses and Disclosures of Protected Health Information -

Your protected health information may not be used by us without your consent, unless required by law or a serious professional concern, arises.

Treatment: We will NOT use your information without your express consent unless there is a safety, legal or professional issue requiring the minimum information necessary to keep people safe and abide by law and our safety and privacy policies.

This is not a clinic, nor do we use third party vendors for payment. We do not accept insurance. NO insurance reimbursement is available to cover our summer programs. For private groups (other than packages or to continue) out of network service receipts can be provided for you to be reimbursed if your plan offers this. 

Your Identity at the one of the NYCB Plaza buildings. Due to building 24/7 security, and free garage parking (which makes for a quicker experience) your name will be used to get to the suite. InspireAmind services so many different people in so many ways, that the “building” doesn’t know why you are visiting. 


As a consulting business and even an organization that networks with parents and businesses in the community, the office staff will not know your protected health information. This and your contact information, as necessary, to contact you to remind you of your appointments.


The services that are provided here,  range from educational, consultation and private practice therapy. We engage in activities that include but are not limited to, quality assessment, employee review, training of students, Licensed Professionals, Counselor Interns, treatment of Adults, Family’s, Adolescents, and Consulting with Educational and Business organizations for community wellness, assessment and Security firms for a safer society.

.

This practice believes in being transparent about your rights and strives to uphold your privacy. Typically, a therapeutic relationship consists of trust and a client that wants to see a positive change. Let’s make that happen together!

You can find more on our Social Media Policy etc. on InspireAmind.net. Thank you.


InspireAmind Counseling, Education & Business Consulting Solutions

Owner & Clinical Director, Marcy Abramsky, LCSW SIFI MST SBA SDA

100 Duffy Ave Suite # 510

Hicksville NY 11801 516-595-3092 *[email protected] *InspireAmind.net

   HIPAA Notice of Privacy Practices (cont.)

II. More on Your Rights

     You have the right to review and receive a copy of your protected health information.

     Our practice will accept such requests in writing.

Under federal law, however, you may not inspect or receive a copy of the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to law that prohibits access to protected health information.

     You have the right to request a restriction on the disclosure of your protected health information.

You have the right to obtain a paper copy of this notice from us.

     III. Complaints

You may file any complaints with us in writing [email protected], or with the Secretary of Health and Human Services

We will not retaliate against you for filing a complaint. We look to serve you.



InspireAmind Counseling, Education & Business Consulting Solutions

Owner & Clinical Director, Marcy Abramsky, LCSW SIFI MST SBA SDA

100 Duffy Ave Suite # 510

Hicksville NY 11801

516-595-3092 *[email protected] *InspireAmind.net

Hours by Appointment Only



Transition To High School Groups

click linck above for schedule and directions

Comprehensive InspireAmindTM Counseling Program Transition  to HS Summer Seminar Group

Registration & Consent





Also 

ADULTS/- DO YOU NEED A *FREE 20 min CONSULTATION RE: Services for your child In MIDDLE SCHOOL?  Click the link! Schedule NOW, committee's meet all summer. There are MANY services your child may be entitled to under the law, even if your child ISN'T CLASSIFIED. BEFORE you start middle start middle school, BE IN THE KNOW.


 


Dear Parents/Guardian/Student,

Our Comprehensive Counseling Program includes an opportunity for Teens to participate in small group counseling experiences. InspireAmind truly believes that this small group setting, positively impacts a Young Adults,  ability to build skills for transition. In additon, we will prepare socially and, for the rigor of increased classroom requirements, needed to move forward in their education, for high school.

Participation in the group should be enjoyable, and confidentiality will be addressed and respected. Please sign the form below to indicate your consent.

In addition, please include comments that might be beneficial when working with this young adult.The anger management group is designed for high school students who are having trouble managing their anger. We will be discussing not only what triggers angry outbursts, but also positive ways to control this anger.)


THESE TOPICS WILL BE ADDRESSED AT A HIGH SCHOOL LEVEL

Being A New Student at A School

Coping with Life Changes

Personal & Social Development

Self Awareness/ Self Control/Anger Management

Tips That Only You Will Know :)

Study Skills / Who and Why to Get to Know Certain Adults

Tips for how to answer a student or teacher in ANY Situation

Enjoyment of This Exciting Change!


School Name For Fall _______________________



Group Pre-Assessment PLEASE COMPLETE

Adult

Before the group started, I hoped ________________________would learn:

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Student

Before the group started, I hoped that I, ___________________________________ would gain..._________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Registration & Consent

Enclosed with this Registration Form and Consent Forms is a 50.00 non refundable deposit to hold their place for the _________________(time) group , on each ____________________ Day for 90 minutes, for 4 consecutive weeks during the month of ___________________, unless there is a holiday (make-up) or ALL the participants agree to another makeup session, due to another reason.

Adult over 21 Signature*  _____________________________________________

Date*___________________________________________________

Student Signature* _____________________________________________

I will participate in this group, and come willingly for appointments.

Date *_______________________


CONSENT FOR TREATMENT OF MINOR

I authorize this practice to provide services for ___________________________________________. I agree to follow-up

with phone conversations regarding progress in therapy and to participate in conversations with my child and or clinician, if recommended.

If I determine of on my own to continue any services, there may be additional charges. Any conversations this clinician seeks to have with me related to my child within the 4 week group period will be included in the fee for that package, unless stated prior, to additional services.

Client Signature x____________________________________ Date__________________________

**Refer to the Information page for the directions, mailing and scheduling at this link and the link at the top Directions and Schedule

InspireAmind Counseling, Education & Business Consulting Solutions

Owner & Clinical Director, Marcy Abramsky, LCSW SIFI MST SBA SDA

100 Duffy Ave Suite # 510

Hicksville NY 11801

516-595-3092 *[email protected] *InspireAmind.net

Hours by Appointment Only

Free 20 Min Consultations for Parents (Individually for their child) on Services (Special Education/504 and State AIS services) in Middle School.


ADULTS/- DO YOU NEED A *FREE 20 min CONSULTATION RE: Services for your child In MIDDLE SCHOOL? Schedule NOW, committee's meet all summer. There are MANY services your child may be entitled to under the law, even if your child ISN'T CLASSIFIED. BEFORE you start middle start middle school, BE IN THE KNOW.


Free 20 Min Consultations for Parents (Individually for their child) on Services (Special Education/504 and State AIS services) in Middle School.

Share this service with your Elementary PTA & SEPTA. 


School districts have tremendous support systems for your children. If identified early, and given the LEAST RESITRICTIVE support, a student can soar to their highest potential


Remember, all you are looking to do is LEVEL the PLAYING FIELD, not enable you child. If that is your goal, you are creating a path to a happy, less frustrated student!