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New Patients · New Jersey

Register online before your first visit.

Complete your intake online before your appointment — personal, insurance, and medical history in one secure form. It takes about 10-15 minutes now, but it means NO paperwork and far less stress on the day of your visit, and gives our clinical team time to actually prepare for you instead of meeting you cold.

A hand filling out a patient intake form on a clipboard
What happens after you submit

Your information goes straight to our clinical team

Nothing about completing this form schedules your visit automatically — a real person reviews what you send and follows up directly. The few minutes you spend now mean our clinical team already knows your history before you walk in, instead of meeting you cold and asking you to fill out the same paperwork again in the waiting room.

  1. Our team reviews your intake, including your medical history and the services you're interested in, before you're ever seen.
  2. We call or email you — usually within one business day — to verify your insurance coverage and answer any questions.
  3. We schedule your first appointment at whichever office works best for you, or as a telemedicine visit.
Get started

New Patient Registration

Complete this form and our team will contact you within one business day to confirm your appointment and verify your insurance. Required fields are marked with an asterisk — everything else can be left blank if it doesn't apply to you.

1 Personal Information

2 Contact Information

3 Reason for Visit

e.g. "Annual physical" or "Anxiety and trouble sleeping for the last few months"
If you'd like us to coordinate with your other providers, list name, specialty, and location.

4 Health Insurance

5 Medical History

Leave any of these blank if they don't apply to you.

6 Lifestyle

Helps us understand health risk factors. Leave any of these blank if they don't apply to you.

7 Family & Preventative History

8 Sexual Health

Sexual health is an important aspect of general health. These questions help us provide complete care.

9 Mental Health Screening

Over the last 2 weeks, how often have you been bothered by the following?

If you're having thoughts of harming yourself right now, please call or text 988 (Suicide & Crisis Lifeline) or go to your nearest emergency room.

10 Mental Health Background

Have you been given any psychiatric diagnoses? If yes, list them.

11 Medical MJ Consent

New Jersey's Medical Marijuana Program requires a specific consent for certification. Reviewing and agreeing here does not itself certify you — our provider will discuss your eligibility at your visit.

12 Additional Information

14 How Did You Find Us?

You can also call us directly at (908) 450-7002 for immediate assistance.

Thank you! Your registration has been received and is on its way to our clinical team. We'll reach out within one business day to verify your insurance and schedule your first appointment.
Submitting… Please wait while we process your information.