Zoom and In-person sessions offered.

Exchange Info Consent

  • Mediation / Collaborative Divorce
    Exchange of Information Consent Form

    JOY A. DRYER, Ph.D.

    Licensed Psychologist/ Psychoanalyst
    PACT Certified Clinician
    NYState License #7740

    92 Remsen Street Ste. 1A, Blyn Heights NY 11201
    31 Collegeview Avenue. Poughkeepsie, NY 12603
    Cell: 917-816-8882

  • We request and authorize the following professionals to exchange information with one another to better facilitate the Mediation and/ or Collaborative Divorce process. Thus, I/ we agree to waive my/ our confidentiality privileges among the professionals involved in my/ our case:

    If not previously revoked in writing, this consent will terminate upon signing the Separation/ Divorce Agreement.

  • MM slash DD slash YYYY