Dr. Jim  Benedick Therapy for Individuals, Couples, & Families

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James Benedick, LCSW, Ed.D.
941-358-0234 (tel)
941-355-4694 (fax)

5104 North Lockwood Ridge Road
Suite 303F
Sarasota, FL 34234

jimbenedick@gmail.com
Helpful Forms

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

  • Client Psychotherapy Intake Form
  • Limits of Confidentiality/Therapy Cancellation Policy

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:

  • Authorization to Disclose Information Form

Registration Form  
Marital and Personal Concerns  
Client Service Agreement  
Records Release Authorization  
Notice of Privacy Practices  
Notice of Privacy Practices Receipt
 
Lifetime Insurance Authorization  

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