new client interest form

Preferred Method of Contact *Check Any That Apply
Best Time To Contact You *Check Any That Apply
How Did You Find HBH? *

Due to NJ laws regarding consent to treatment, we will need to speak directly to any potential client over the age of 16 prior to scheduling an appointment.

Who Are You Seeking Treatment For? *
Age Group of Person Seeking Treatment *
Therapy You Are Seeking? *
Have You Been In Therapy Before? *
Preferred Method for Therapy *Check Any That Apply
Your Availability for Sessions *Check Any That Apply
Reason For Seeking Treatment *Check Any That Apply
0 / 50
Have You Been Diagnosed With ANY of the Above Selected Disorders? *

Yes, I agree that I have provided my information to best of my knowledge and agree to being contacted by HBH Counseling.