Client forms

Complete your forms online.

Choose the forms you need and complete them before your visit. Call our office if you need help choosing the right form.

New clients

Online form

Child Intake Form

Use this form for a child under age 18.

Online form

Client Intake Form

Use this form for a teen or adult age 18 or older.

Online form

Confidentiality and Cancellation

Read the rules for privacy, visits, and missed visits.

Online form

Electronic Communication

Choose how the office may call, email, or text you.

Online form

Telehealth Consent

Read the terms for online therapy and give your consent.

Privacy & coordination

Online form

Medical Information Disclosure

Let the office share health records when needed.

Online form

Release Form

Let the office talk with a provider, school, or person you name.

Online form

Disclosure Agreement

Read and accept the practice disclosure.

Safety

Online form

Safety Plan

Make a plan that can help you stay safe.

Common questions

Questions about the forms.

Use these answers to pick a form. Explore our therapy services or team before you get started.

Woman reviewing paperwork at home with a pen and laptop nearby
Which intake form should I choose for a child?

Use the Child Intake Form for a child under 18.

Which intake form is for adults?

Use the Client Intake Form for anyone age 18 or older.

What if I need help choosing a form?

Call 732-672-2347 if you’re unsure which form to choose. The office can help you find the right form for your visit.

Can I email a completed form or health details?

Please do not email forms or private health details. Call the office if you need help.

Which insurance plans do you accept?

The practice lists UnitedHealthcare, QualCare, ValueOptions, Cigna, and Aetna. Benefits and costs can vary. Call your plan before your first visit to check your coverage.

Will my plan cover every therapist?

Coverage can vary by plan and therapist. Call your insurance company and the office before your first visit. Ask about network status, benefits, and costs.

How can I check my insurance coverage?

Call your health plan. Ask about mental health care, visit costs, out-of-network care, and any rules. You can also view the rates and insurance page.

Need help getting started?

We’re here to help with the next step.

Call the Freehold office with questions about forms or appointments.

Call 732‑672‑2347Request an appointment

Authorization for Electronic Communication

Child/Adolescent Intake Form

Client Intake Questionnaire

Confidentiality and Cancellation Form

Disclosure Agreement – Authorization for Protected Health Information

Medical Information Disclosure – Notice of Privacy Practices

Release Form – Practice Policies and Insurance Authorization

Safety Plan

Telehealth Informed Consent