Patient Forms
New patients will need to fill out several forms before therapy can begin. To make the process as smooth and efficient as possible, we provide the most important documents as downloads right here on our website.
Find out which forms you need to submit, select the appropriate download link and return the completed documents to our practice either in person, by fax or as a scanned PDF file via e-mail.
Naturally, all forms are also available at the practice; however, filling them out in advance saves time.
If you are unsure which forms to fill out, don't hesitate to contact us.
Contains essential patient information as it relates to treatment. Includes personal information, medical history and an emergency contact number.
Client Intake Form.pdf
Adobe Acrobat document [233.0 KB]
This document details your rights and responsibilities as a patient at Leslie F Small Professional Counseling Services. We are bound by these terms, and ask in return that you agree to them as well.
Bill of Rights and Informed Consent for [...]
Adobe Acrobat document [399.2 KB]
This document allows for the communication between your behavioral health provider and your primary care physician. This is an important form to ensure that all providers involved in your care are co
Authorization to Disclose to PCP.pdf
Adobe Acrobat document [221.2 KB]
This document allows your behavioral health provider to disclose information to the person of your choosing. This form is entirely optional and, if signed, may be revoked at any time.
General PHI Disclosure Authorization.pdf
Adobe Acrobat document [221.0 KB]
This form conveys specific information from your behavioral health provider to the physician of your choosing.
Clinician Communication Form.pdf
Adobe Acrobat document [150.8 KB]
This is a comprehensive intake and assessment form that takes a snapshot of several aspects of your life and how they may fit into your current situation.
Biopsychosocial.pdf
Adobe Acrobat document [422.7 KB]
This is a document that identifies your goals, objectives and the interventions to be used in your treatment. This form is done along with your behavioral health provider.
Treatment Plan.pdf
Adobe Acrobat document [109.2 KB]
Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.
Where to Find Me:
Leslie F Small Professional Counseling Services
9 Davison Avenue
Suite #7
Jamesburg, NJ 08831
Phone: (732) 997-0214
leslie.small@lfsprofessionalcounseling.com
Office Hours
Hours are by appointment only:
Monday - Tuesday
9:00AM - 9:00PM
Wednesday - Friday
9:00AM - 5:00PM
Patient Forms
New client? Save time and reduce the amount of paperwork you have to fill out at your first visit. We provide several patient forms as PDF downloads on our site.
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