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Registration for Healthy Minds Group Therapy

We’re excited to have you!

Please use the form below to express interest and apply to one or more of our group courses. You will be contacted shortly afterwards to answer any questions you may have and learn the next steps (consent to participate, payment authorization, etc.)

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Today's Date *

Participant's Name *

First

Last

Participant's Date of Birth *

I'm filling this request out for *

Myself
My partner
My child
Other

Your Name *

(required if filling out the form for someone else)

What is your relationship to the group participant? *

Your Email *

Select which group(s) you or your child are interested in joining *

Teen Anxiety Course (ages 13-17)
DBT Skills Group (Adults)
Adult Anxiety Group (coming soon)
Men's Stress Group (coming soon)
Parenting Group (parents of teenagers, coming soon)
Mothers Group (mothers of infants, coming soon)

Tell us more about your interest in the group(s) you checked above. What are you looking to draw from the experience? *

How did you first hear about our group courses?

Friend or colleague
Online Ad
Web search
Social Media
Other

Are you currently a patient at IPG? *

What's your therapist's name?

You may click submit, and your application will be reviewed and forwarded to the group coordinator.

Required Participant Information

Since you are a new client, the fields below are required in order to enter the participant into our software.

Client Address *

Address Line 1

Address Line 2

City

State

Zip Code

Client Gender *

Client Marital Status *

Main Phone *

Emergency Contact *

First

Last

Phone *

Payment/Insurance Information

How will you be paying for treatment? *

Client's relationship to primary insurance holder *

Self
Spouse/Partner
Child
Other

Name of primary insurance holder *

Date of birth of primary insurance holder *

Subscriber/Member ID# *

Primary Insurance Company *

Please upload a copy/pic of your insurance card (front) *

Click or drag a file to this area to upload.

PNG, JPG, DOC, or PDF Format Only

Please upload a copy/pic of your insurance card (back) *

Click or drag a file to this area to upload.

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From our Facebook Page

Insight Psychological Group

1 month ago

An extremely underrated piece from The Atlantic, with significant impact for mental health and psychotherapy. Going way beyond death and suicide, in a few pages, David Brooks proposes a major revision to the Western ideal of self-autonomy, self-importance, and self-care. Worth the read! ... See MoreSee Less

Canada Legalized Assisted Suicide—And Exposed the Limits of Liberalism

www.theatlantic.com

What happens when a society takes individualism to its logical conclusion?

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OFFICES

Westfield
773 Central Ave.
Lower Level
Westfield, NJ 07090
908.228.2740

Maywood
240 W. Passaic St.
Suite 10
Maywood, NJ 07607
201.817.5747

TREATMENT SCOPE

Depression, Anxiety & Panic Disorders, Stress & Anger, ADHD & School Problems, Family & Relationships, Divorce, Trauma, Couples Counseling, Grief & Loss, Chronic & Terminal Illness, Personality Disorders, Evaluations & Reports

AREAS WE SERVE

Insight Psychological Group provides quality therapy and counseling to people of all backgrounds and with a large variety of issues. We proudly serve Bergen, Passaic, and Union Counties of New Jersey, including: Westfield, Cranford, Scotch Plains, Clark, Garwood, Fanwood, Mountainside, Linden, Rahway, Kenilworth, and Roselle Park; Teaneck, Bergenfield, Hackensack, Bogota, New Milford, Englewood, Leonia, Maywood, Paramus, Elmwood Park, Rochelle Park, River Edge, Fair Lawn, Saddle Brook, Paterson, and Lodi.

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