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
Telemental Health Informed Consent
Inform you about our policies and procedures regarding Telemental Health Services and to ensure your agreement to these services.
Please read and bring a signed copy with you on your initial visit.
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.r1737172826etnec1737172826gnile1737172826snuoc1737172826evisn1737172826eherp1737172826moc@r1737172826etynz1737172826sm1737172826 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.
Please fill out the form and email to ten.r1737172826etnec1737172826gnile1737172826snuoc1737172826evisn1737172826eherp1737172826moc@r1737172826etynz1737172826sm1737172826 or bring with you on your first visit.
Men’s Health History
This form is used for men in the Food, Mood and Healthy Living Group to provide health history information.
Please fill out the form and email to ten.r1737172826etnec1737172826gnile1737172826snuoc1737172826evisn1737172826eherp1737172826moc@r1737172826etynz1737172826sm1737172826 or bring with you on your first visit.
Gender Neutral Health History
Gender neutral form for the Food, Mood and Healthy Living Group to provide health history information.
Please fill out the form and email to ten.r1737172826etnec1737172826gnile1737172826snuoc1737172826evisn1737172826eherp1737172826moc@r1737172826etynz1737172826sm1737172826 or bring with you on your first visit.
Female Teen Health History
This form is used for female teens in the Food, Mood and Healthy Living Group to provide health history information.
Please fill out the form and email to ten.r1737172826etnec1737172826gnile1737172826snuoc1737172826evisn1737172826eherp1737172826moc@r1737172826etynz1737172826sm1737172826 or bring with you on your first visit.
Male Teen Health History
This form is used for male teens in the Food, Mood and Healthy Living Group to provide health history information.
Please fill out the form and email to ten.r1737172826etnec1737172826gnile1737172826snuoc1737172826evisn1737172826eherp1737172826moc@r1737172826etynz1737172826sm1737172826 or bring with you on your first visit.