Welcome to Counseling Services Inc.
1605 John Street, Suite 314, Fort Lee, NJ 07024
5 West 20th Street, Fifth Floor, New York, NY 10010

Patient Forms for our Clients at Counseling Services Inc.

Forms and paper work must be filed between you and your therapist, just like any other health care service. It is the clients responsibility to keep the therapist up to date with any changes in your personal information and insurance status.

New Client Instructions:

If you're a new patient, please download, print, and complete all 3 information forms. Bring them to your first appointment. Filling out these forms prior to your visit, will save you time in our consultation room and give you more time to begin therapy. 

  * click this first graphic icon on the left, a dialogue box will open. Click 'save file' and click 'OK'  to download all 3 forms. ** You must 'save' the file first in order to open these file. 
  1. Before your first visit to meet our therapist, print these 3 forms and complete the required information.
  2. Bring those forms on your first visit.
  3. On your first visit, bring a photo ID and an insurance card. If possible, also bring in a scanned copy of that insurance card you can leave with us. (If you do not have access to a printer we can scan it for you).

CSi Information Package:

     * click this second graphic icon on the left, if you are a new client or a client who would like to review CSi's information package. This package includes our privacy practices, and service policies, along with our introductory news letter

Please help to keep your personal records up to date. You can reprint this form at anytime and bring it with you to your next therapy session:

If your personal information changes, such as insurance coverage, address, contact information, name changes etc.. , You are responsible for keeping your records up to date with your therapist. To update your records, please re-submit the patient information forms.

* click this third graphic link on the left and download this form to update your records.
  1. Print out one form and complete the required information.
  2. Bring this form with you on your next visit. If your insurance card has changed, please bring it with you on that visit. If possible, also, please bring a scanned copy of your insurance card with you.

Divorce Mediation web page is password protected.

Your Divorce Mediator will provide a temporary username and password for you on your first visit. All information on this page is confidential and protected by copyright laws. This page is not accessible to the public.
[this form is not available without a password issued to you by one of our CSi counselors]. *click the graphic link on the left, download and print this form and fill in the required fields. 

  1. Print out two information forms. One for each partner and complete the required information. 
  2. Bring this form with you on your first divorce mediation consultation. If possible, also, please bring a scanned copy of your photo id, such as a drivers license or passport with you.
  • Information about divorce mediation and any of the forms provided by CSi for filing a divorce can be downloaded on the next web page under Divorce Mediation. In order to access these pages, you will need a special username and password. The username and password will be provided to you by your mediator at the time of your appointment.
  • All information on this page is confidential and protected under copyright laws. In order to protect your confidentiality the password for using this page is change frequently. If you have difficulty accessing this page ask your Mediator for a new password.