Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

If you are interested in ACT Boot Camp, complete the following registration form and return with $50 deposit.

ACT Boot Camp Registration Form


Note: To download Adobe Acrobat Reader for free, click here.

Helpful Forms

Click here to view and print forms for your appointment

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Marek Moldawsky, M.Ed.; Ed.S.

239-834-9333

1314 Cape Coral Parkway East Suite #210
Cape Coral, Florida 33904


[email protected]