Switch to Accessible Site
Therapy for IndividualsCouples, & Families
Family Therapy Session

Appointment Request & Forms

We appreciate that you have chosen our center and hope you will find your experience here productive and enjoyable. At PGSC, we believe that health care is a two way street. That means that in addition to providing you with excellent health care, we are also very much aware that you are a “consumer with choices” and that our success depends on your having an outstanding experience here. As such you will always be treated in a dignified way at our center. No gruff receptionists or therapists or billing people, always being seen within a few minutes of your appointment time and always finding us available to discuss your needs and concerns. To that end, if at any time you have questions about clinical or administrative issues, please feel free to call us directly at (908) 431-5254 and we will address your concerns. Our administrative staff is available by phone Monday - Friday from 11am-4pm. If you get our voicemail, we will be back in touch with you within those hours. 

If you have already scheduled an appointment, please fill out the following forms.

If you would like to make a request to schedule an appointment, please fill out the appointment request form at the bottom of this page or call (908) 431-5254.

We are required by law to provide you with certain forms which let you know how our practice operates and what your rights are as a patient. Please fill out or sign the following documents prior to your first visit. You can either fill them out online or print and bring them to your first session. 


Please Read and keep for your records:

 Noticy of Privacy Practices - HIPAA

Please fill out, sign and submit the following forms:

1) Personal Information Sheet (Please take the time to fill out this form in detail so we can get to know you)
2) Medication sheet 

3) Confidentiality Form
4) Acknowledgement of Privacy Practices 

5) Cancellation Policy Form

6) Authorization Form
7) Group Counseling Form (Required only if you are interested in joining a group)
8) Group Information Packet and Contract 
(Required only if you are interested in joining a group)

**If you do not wish to submit forms online, please print the following and either bring to your first session or mail to PGSC at least one week prior to your first session so we have time to review. 

1b) Personal Information Sheet
2b) Medication Sheet
3b) Confidentiality Form
4b) Acknowledgement of Privacy Practices 

5b) Cancellation Policy
6b) Authorization Form

7b) Group Counseling Form (Required only if you are interested in joining a group)
8b) Group Information Packet and Contract (Required only if you are interested in joining a group)


We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

Please don't put anything here:
Please enter the words below: Click to reload image What is this?

By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.