New Patient Forms

Forms

Before your first session, you’ll be asked to complete several intake forms. These forms vary depending on the provider, but here’s a general overview of what you can expect:

  1. Contact Information Page: This form collects your personal details (like your name, address, phone number, and preferred method of contact) so we can maintain accurate records and reach you as needed.

  2. Office Policies/Signature Page: This page outlines key policies, including an acknowledgment of informed consent, confidentiality guidelines, office procedures, client rights and responsibilities, and the financial agreement. By signing, you confirm you’ve reviewed and understood these terms.

  3. Notice of Privacy: This form explains how your privacy is protected under HIPAA (Health Insurance Portability and Accountability Act) and details how your personal information will be handled.

  4. Intake Form: This form helps your therapist understand the reasons you’re seeking therapy and provides a brief overview of your psychological history, which will guide your treatment.

  5. Release of Information: This gives your consent for your therapist to share information with other professionals or third parties, if necessary, as part of your treatment plan.

If you have any questions about these forms or need further clarification, don’t hesitate to reach out!

South Jersey Psychological & Counseling Services, LLC

140 S. Broadway Suite #7
Pitman, NJ 08071

Phone & Fax: (844) 365-7676