• Call Us: (609) 688-8300
  • Our Address: 182 Tamarack Circle, Skillman, NJ 08558
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Forms for Clients

Intake Forms

Below please find our intake forms for new clients. Please complete prior to your first appointment with your practitioner.

General Forms

Below, please find our general intake forms. All new clients to Ivy Counseling Group are required to complete all of these forms.

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Office Guidelines and Policies

This form outlines Ivy Counseling Groups office policies and procedures. All clients must review and complete this form.

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Client Health Information

This form collects contact, billing, and insurance information. We also ask for information regarding your reason for utilizing our services. All clients must complete this form.

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Notice of Privacy Practices

This form should be completed by all clients after review of the Notice of Privacy Practices Sheet.

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Notice of Privacy Practices Sheet

All clients should review this sheet and then sign the above Notice of Privacy Practices form.

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Medical Release Form

This form should be completed by clients who wish to have their practitioner consult outside services, including primary physician, referring practitioner, education professionals, etc. Completing this form is not necessary for all clients and is based solely on client need.

Specialized Forms

Please select the intake form relevant to your appointment type (Counseling, Nutrition, Reiki, etc) and complete the corresponding form. You do not need to complete all of the forms below, only the form that pertains to your appointment.

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Aromatherapy Intake Form

All adult clients meeting with an aromatherapist (Susan Niedt, CA) should complete this form and bring it to their first appointment.

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Counseling (Adult) Intake Form

All adult clients meeting with one of our counselors (therapists) (Jean Robinson LPC, Debra Ruisard DSW) should complete this form and bring it to their first appointment.

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Counseling (Children and Adolescent) Intake Form

All child or adolescent clients meeting with one of our counselors (therapists) (Mahuya Ghosh Ph.D, Lisa Zaneto LPC, Jean Robinson LPC) should complete this form and bring it to their first appointment.

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Energy Medicine Intake Form

All clients meeting with an Eden Energy Practitioner (Alla Rosina) or receiving energy medicine treatment should complete this form and bring it to their first appointment.

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Nutrition Counseling Intake Form

All clients meeting with a registered dietitian/nutritionist (Katie Gaffney, RDN) should complete this form and bring it to their first appointment.

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Reflexology Intake Form

All clients meeting with a reflexologist (Chris Niedt CR) should complete this form and bring it to their first appointment.

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Reiki Intake Form

All clients meeting with a Reiki Master (Chris Niedt RM RMT) should complete this form and bring it to their first appointment.