START YOUR JOURNEY TO A BETTER TODAY! CALL US TODAY. (732) 866-8611

(732) 866-8611

(732) 866-8611(732) 866-8611(732) 866-8611

(732) 866-8611

(732) 866-8611(732) 866-8611(732) 866-8611
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  • Why Therapy? CONTACT US
  • In-Take Forms
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    • Home
    • About Us
    • Why Therapy? CONTACT US
    • In-Take Forms
    • CLIENT PORTAL
  • Home
  • About Us
  • Why Therapy? CONTACT US
  • In-Take Forms
  • CLIENT PORTAL

in-take forms

REQUIRED FOR ALL CLIENTS

REQUIRED FOR ALL CLIENTS

REQUIRED FOR ALL CLIENTS

ALL CLIENT TYPES ARE REQUIRED TO COMPLETE THESE FORMS IN ADDITION TO YOUR INTAKE FORMS.

REQUIRED FORMS

ADULT INTAKE FORMS

REQUIRED FOR ALL CLIENTS

REQUIRED FOR ALL CLIENTS

For clients 18 years of age or older, please complete these required forms.

REQUIRED FORMS

CHILD/ADOLESCENT INTAKE FORMS

CHILD/ADOLESCENT INTAKE FORMS

CHILD/ADOLESCENT INTAKE FORMS

For clients under the age of 18 years of age, please complete these required forms.

REQUIRED FORMS

COUPLES INTAKE FORMS

CHILD/ADOLESCENT INTAKE FORMS

CHILD/ADOLESCENT INTAKE FORMS

For couples, please complete these required forms for each client.

required forms

DZ COUNSELING CLIENT PORTAL

UPLOAD FORMS

Click the link below to upload forms to your client portal.

DZ COUNSELING SECURE PORTAL

Required forms for all clients

Services & Billing 2022 (pdf)Download
Release and or Receive Authorization 2022 (pdf)Download
Psychotherapy Informed Consent 2022 (pdf)Download
HIPAA Privacy Policies 2022 (pdf)Download
Email Text Consent Form 2022 (pdf)Download
Telehealth Consent 2022 (pdf)Download
Neurofeedback Consent 2022 (pdf)Download

INTAKE FORMS-adults/18 and older

Adult intake Form 2022 (pdf)Download

INTAKE FORMS-Child 17 & UNDER

Child Intake 2022 (pdf)Download

INTAKE FORMS-couples

Couples Intake Form 2022 (pdf)Download

other office forms

Client Update Form 2022 (pdf)Download
Release and or Receive Authorization 2022 (pdf)Download

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