Forms

Comprehensive Counseling Center forms are available for download below. Having these forms completed and signed before you visit our office will help us to serve you more efficiently. Any questions or comments you may have regarding the required paperwork can be explained and/or discussed with you upon your office visit. You may also call our office if you require any assistance downloading or completing the forms at 732.987.9770.

Telehealth Informed Consent Form

Inform you about our policies and procedures regarding Telemental Health Services and to ensure your agreement to these services.

Download

HIPPA Privacy Policy Form

Describes how health information about you may be used & disclosed, & how you can get access to this information.

Download

Financial Responsibility Form 2025

Describes your financial responsibility as a patient of the practice

Download

Client Information Form

Client contact and insurance information.

Download

Client Information & Informed Consent

This form provides information regarding the professional obligations between the client and therapist.

Download

Self-Assessment Form

This form will help our therapists get an understaning on what you would like to get accomplished.

Download

Couples Addendum Form

Describes your rights to privacy as a couple attending therapy.

Download

Medical History Form

Brief medical history questionnaire.

Download

Authorization to Release

This form will give your therapist permission to talk/provide information to another person/facility.

Download

Claim Form

This form is used for clients who have the ability to see a therapist “out of network"

Download

Forms

Telehealth Informed Consent Form

Inform you about our policies and procedures regarding Telemental Health Services and to ensure your agreement to these services.

HIPPA Privacy Policy Form

Describes how health information about you may be used & disclosed, & how you can get access to this information.

Financial Responsibility Form 2025

Describes your financial responsibility as a patient of the practice

Client Information Form

Client contact and insurance information.

Client Information & Informed Consent

This form provides information regarding the professional obligations between the client and therapist.

Self-Assessment Form

This form will help our therapists get an understaning on what you would like to get accomplished.

Couples Addendum Form

Describes your rights to privacy as a couple attending therapy.

Medical History Form

Brief medical history questionnaire.

Authorization to Release

​This form will give your therapist permission to talk/provide information to another person/facility.

Claim Form

This form is used for clients who have the ability to see a therapist “out of network"

This form will give your therapist permission to talk/provide information to another person/facility.