Patient Forms

 

Please review and print the Patient Forms prior to your first appointment.

 

Our goal is to provide the best comprehensive and quality care to our patients. This level of care cannot be provided with the limitations, rules and time constraints set by insurance companies.  Our practice values the investment of time determining the right treatment plan and care for our patients and their mental health. As a result, we have opted out of all health insurance plans.

However, if you do have out-of-network benefits, receipts can be provided upon request for you to submit to your insurance plan/Flexible Reimbursement or Health Savings Account to cover for fees and visits. All major credit cards are accepted for payment.

 

  1. Clinician-Patient Services Agreement

  2. Authorization for Release

  3. New Jersey Notice Form

  4. New Patient Form

  5. Credit Card Authorization Form

  6. Primary Care Physician Form (PCP) Consent for Release