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Forms

Required*

First time clients must fill out this intake form before treatment and e-mail it to lchaughwout@gmail.com

Required*

First time clients must sign this contract before treatment and e-mail it to lchaughwout@gmail.com

Optional

This form is the authorization for the release of confidential information, which is optional 

lchaughwout@gmail.com

Contact

Luciana C. Haughwout

Connecting Wellness Center Founder (Counsellor/Coach)

Email: lchaughwout@gmail.com

Phone: (914) 214-8725

 

360 Underhill Avenue

Yorktown Heights, NY 10598

​

Yorktown Heights, NY / Manhattan, NY

Hours: Monday - Friday / 7 am - 5 pm

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