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FormsDeborah Kourgelis, LCSW, LCADC2022-11-22T18:40:46+00:00

Please download the below forms, complete and send or fax back to us.

Cancellation Policy

Clinical History Form

Consent for Treatment of a Minor

Credit Card Authorization

Informed Consent Form

Personal Information Sheet

Statement of Confidentiality

Telemental Health Informed Consent

Authorization for Electronic Communication

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Crossroads Counseling & Psychotherapy

Deborah Kourgelis, LCSW, LCADC
Therapy in New Jersey, New York & Florida
[email protected]
201-694-1648

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