SoS Couples Appointment form
Please fill out the following form so we can figure out how best to help you.

For couples therapy, both partners are required to actively participate in the scheduling process and complete all required paperwork prior to the first session. This helps ensure a balanced and informed start to the therapeutic process. Appointments cannot be confirmed until all parties have completed these steps.

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Are you or your partner: *
Required
Are you located in New Jersey? Currently our couples therapist can only see clients who reside in NJ. *
[Partner 1] First and Last Name  *
[Partner 2] First and Last Name *
[Partner 1] Email *
[Partner 2] Email *
[Partner 1] Phone number *
[Partner 2] Phone number *
What brings you to Symmetry? Check all that apply. *
Required
Do you prefer in-person or remote telehealth services? 
(We are physically located at 1007 Mantua Pike Suite 105 Woodbury, NJ)
 *
Symmetry only takes a few insurance plans. Our couples therapist's out-of-pocket fee is $110/session. How do you want to pay for your sessions? (She can ONLY TAKE THE INSURANCES LISTED BELOW, We no longer take BCBS plans and we do not take Medicare/Medicaid) *
Required
**We do not verify insurance benefits. Please call the number for behavioral health on the back of your card to check if Symmetry of Self is in-network with your plan.**
This form will help you with what to ask
What times/days work best for you? *
Required
Have either of you ever had involvement or investigations with the NJ Division of Child Protection and Permanency (DCPP)? *
How did you hear about us? Who referred you? *
We will get back to you
If you are in crisis please find your nearest emergency room or crisis center or dial 911 or 988. We will get back to you as soon as we can.

Our reply may occasionally land in spam or junk mail, so please check those folders if you don’t hear from us.
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