Client Forms

Prior to the initial appointment, please review the HIPAA form and the intake form, print, complete and bring with you to the initial appointment.

For couples counseling, I ask that each member of the couple individually complete this form.

For adult individual therapy please complete this form.

For minors receiving therapy the parent/guardian should complete this form.

For clinical supervision please complete these forms:

 

Contact Today



320 Raritan Ave Suite 204 B
Highland Park, NJ 08904

pat@btccounselingnj.com
(732) 354-2590

Got Questions?
Send a Message!

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.