Make an Appointment: [email protected] | (201) 906-5726

Patient Forms for our Clients at Counseling Services Inc.

  • Board Certified Psychotherapist
  • Licensed Clinical Social Worker
  • Licensed Professional Counselor
  • Certified Counseling Supervisor

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 2 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 submit another patient information form.