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.

Form Name

Description

Instructions

Hippa Privacy Policy Form

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

Please read and bring a signed copy with you on your initial visit.

Client Information

Client contact and insurance information.

Please bring completed copy with you on your initial visit.

Client Information & Informed Consent

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

Please read and bring a signed copy with you on your initial visit.

Self Assessment Form

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

Please bring completed copy with you on your initial visit.

Couples Addendum Form

Describes your rights to privacy as a couple attending therapy.

Please read and bring a signed copy with you on your initial visit if you will be undergoing couples therapy.

Medical History Form

Brief medical history questionnaire.

Please bring completed copy with you on your initial visit.

Authorization to Release

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

Please sign and bring with you on your initial visit

Claim Form

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

Please fill out the box title “patient information” and bring with you on your first visit.

Food, Mood and Healthy Living Group Forms

Below are the forms for the Food, Mood and Healthy Living Group. Please contact Mary Sznyter at 732-577-9792 or ten.r1545204762etnec1545204762gnile1545204762snuoc1545204762evisn1545204762eherp1545204762moc@r1545204762etynz1545204762sm1545204762 with questions about these forms.

Form Name

Description

Instructions

Women’s Health History

This form is used for women in the Food, Mood and Healthy Living Group to provide health history information.

Men’s Health History

This form is used for men in the Food, Mood and Healthy Living Group to provide health history information.

Gender Neutral Health History

Gender neutral form for the Food, Mood and Healthy Living Group to provide health history information.

Female Teen Health History

This form is used for female teens in the Food, Mood and Healthy Living Group to provide health history information.

Male Teen Health History

This form is used for male teens in the Food, Mood and Healthy Living Group to provide health history information.

2358 Route 9 South, Suite 5B

Howell, NJ 07731

Phone: 732.987.9770

Fax: 732.987.9769

Contact Us Today