New Client Inquiry Form

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Thank you for contacting us.

Please note that this is not a forum to obtain crisis services. If you or your loved one need emergent help, please call 911 or go to your nearest emergency room.

We understand that it takes courage to reach out. Our mission is to provide you with the best treatment to help you achieve your goals. Congratulations on taking a step towards a better life!

Our practice is out-of-network with all insurance companies. This means that you may receive reimbursement if you have out-of-network benefits. We also accept HSA, FSA, and HRA cards. We have a list of questions on our website that you can ask your insurance company about your benefits: https://cfcenj.com/get-started/out-of-network-insurance/

We have a range of fees and session types. Therapists' fees are listed on their profile page on our website. https://cfcenj.com/about-us/therapists/

It is helpful if we have detailed information about your concerns. Please also provide details about your availability.

Thank you! We are looking forward to serving you!

Email *

Name *

Please specify who you making this inquiry for *

Myself

My child

My spouse

Name of client (if not yourself)

Date of birth of client *

YYYY

City *

State *

Zip code

Phone number *

How did you hear about CFCE? *

What issues and concerns are you wanting to address in psychotherapy at this time? *

Do you prefer in person or virtual sessions? (See https://cfcenj.com/online-therapy/ for more information about virtual sessions.) *

Virtual sessions

In-person sessions

Either could work

I'm flexible because I want to get an appointment as soon as possible.

Required

Please let us know if you have a specific preference for a therapist (e.g. a therapist of a certain age, gender, ethnic/racial background, etc.)

What is your availability for therapy sessions? Please note that having more times available makes it easier for us to accommodate you. *

Do you have any other questions? Is there anything else you want us to know? Please share here.

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This form was created inside of Center for Counseling and Education, LLC.