New Client Forms

New Client Forms For Counseling In Center City, Philadelphia PA, Ocean City NJ, Alpharetta GA, Richmond VA and Telehealth in Florida. 

FORMS : INDIVIDUAL COUNSELING 

• New Client Form
• Personal Data Form
• Client Agreement
• Telemedicine Form

FORMS: COUPLES COUNSELING

• New Client Form
• Couples Personal Data Form
• Client Agreement
• Telemedicine Form

FORMS: CHILDREN AND TEEN COUNSELING

• New Client Form
• Child Personal Data Form
• Child Agreement
• Parent Agreement
• Telemedicine Form

FORMS: FOR COORDINATING CARE

• Client Care Communication (for doctors)
• Release / Obtain Health Care Information (everyone)

FORMS: INSURANCE 

• We are out of network with all insurance companies.  
• To determine your out of network rates
• Insurance Reimbursement Form - this form must be filled out for us to submit the bill for you.  

New Client Forms For Virtual Counseling

1. After scheduling an appointment all of your forms that you need to complete will automatically be sent to your email.  These forms will be "responsive" and you can fill them out online without needing to print them first.  You can then send them back to us using your secure client portal.  All of the above forms must be printed and manually filled out.  

If you choose to Fax or snail mail the forms back to us, please let your therapist know that you are doing so. If possible, we prefer that you upload the forms directly into our secure virtual portal.  Your therapist can explain the process to you. 

Old Style Communication (that works, we just aren't in the office every day)

Fax:  215-922-6302
Address: Center For Growth
                 Attention: Telephone Counseling Department
                 233 S 6th Street, Suite C33,
                 Philadelphia PA 19106

The above forms are used at the Society Hill Therapy Office location, as well as our Fairmount Therapy Office location.  Telehealth service forms will be emailed to your email address.