Comsewogue Public Library Community Resource Referral

Hello,

Thanks for visiting the Comsewogue Public Library! Please fill out this form so I can better assist you. Fill out as many of the blanks below as you would like. The more information provided, the faster I may be able to help you but you can leave some lines blank! I will be available to assist with advice, information and referrals over Zoom, phone, or email on Tuesdays and Thursdays from 10am – 3pm. These appointments are not therapy sessions; referrals will be given to people looking for clinical therapy.

Sincerely,
Gina
SBU Social Work Intern

First Name *

Your phone number/email/best way to contact you *

Are there any children in your household? If yes, how many?

Are you fleeing a domestic violence situation?

Have you been diagnosed with a mental health issue by a doctor?

What do you currently need assistance with? (Check all that apply)
HousingPaying utility billsApplying for benefits (ex: Medicaid, SNAP, SSI/SSD)EducationMedical IssuesMental Health IssuesSubstance UseEmploymentCare Coordination/Case managementOther

Confidentiality Notice: This document (including any attachments) may contain confidential, proprietary, privileged and/or private information. The information is intended to be for the use of the individual or entity designated above. Any disclosure, reproduction, distribution or other use of this document or any attachments by an individual or entity other than the intended recipient is prohibited.

COMSEWOGUE PUBLIC LIBRARY
170 Terryville Road
Port Jefferson Station, NY 11776

COMSEWOGUE PUBLIC LIBRARY
170 Terryville Road
Port Jefferson Station, NY 11776

HOURS
Monday-Thursday 9:30 am - 9 pm
Friday-Saturday 9:30 am - 5 pm
HOURS
Monday-Thursday 9:30 am - 9 pm
Friday-Saturday 9:30 am - 5 pm

CONTACT
Phone (631) 928-1212
Fax (631) 928-6307

CONTACT
Phone (631) 928-1212
Fax (631) 928-6307