FOR PROSPECTIVE CLIENTS SEEKING INITIAL APPOINTMENT WITH ONE OF OUR PROVIDERS:
Kindly fill out these forms and email back at
. It can also be faxed at (908) 272-7502. firstname.lastname@example.org and driver's license. Do not forget to include copies of your insurance card (FRONT & BACK) . The sooner we get this back from you, the sooner we can call you to set up an appointment. NO COPIES OF INSURANCE CARD/S, NO APPOINTMENT
CJBH INTAKE FORM (WORD DOC)
NEW OFFICE POLICY
FOR SCHEDULED CLIENTS ONLY
If you have been scheduled for your initial appointment, you are requested to arrive 15 minutes earlier so you will have time to fill out these forms. If for some reason that this is not possible for you, you can print these forms and bring it on your initial appointment.
CJBH Registration Form
CREDIT CARD/DEBIT CARD AUTH - If you wish that your credit/debit card to be kept on file to pay for your copays, coinsurances, deductibles and other patient/family responsibility.
Credit Card Auth Form
2. AUTHORIZATION TO RELEASE AND DISCLOSE PATIENT INFORMATION
Release Records Form
CJBH INTAKE FORM - PDF FILE CJBH INTAKE FORM - WORD FILE CJBH INTAKE FORM - PDF FILE CJBH INTAKE FORM - WORD FILE CJBH INTAKE FORM - PDF FILE CJBH INTAKE FORM - WORD FILE CJBH INTAKE FORM - PDF FILE CJBH INTAKE FORM - WORD FILE
Cranford, New Jersey
Central Jersey Behavioral Health, LLC
216 North Ave. East 1st Flr
908-272-7500 More Information
Vincent Lim, M.D.
Dr. Lim's educational background includes Post Graduate Year IV/Fellowship in Psychopharmacology and Biological Psychiatry at Albert Einstein School of Medicine in Bronx, New York; Post Gr
Bruce Schweiger, M.D.
I have had extensive experience in both outpatient and inpatient psychiatric settings. I have had extensive experience in treating adults, adolescents and children in psychopharmacology a
Anwar Ghali, M.D.
Dr. Ghali is a Diplomate both in Psychological Medicine and Internal Medicine (Faculty of Medicine, Cairo University, Cairo Egypt) and has an MPA in Health Services Management (New York University). He also is Board Cerfified in both American Board of Psychiatry and Neurology and Administrative Psychiatry. His Post-Doctoral Training includes: Rotating Internship at Cairo University Hospitals; Resident Psychiatry at Ahmed Maher Teaching Hospital
Caroline Farrales, M.D.
Dr. Caroline Farrales is Board Certified in General Psychiatry and Board Eligible in Geriatric Psychiatry. She earned both her Medical Degree and undergraduate course in B.S. G
Lucie Alexis Skidanow, LCSW
Lucie Skidanow is a highly skilled bi-lingual (English/Spanish) Psychotherapist with extensive experience with individual, group and family therapy with children, adolescents and adults.
Roy Hirschfeld, MA, EDS
I specialize in Marriage and Family therapy, depression resolution, techniques for reduction in anxiety and work very well with children of all ages and teens. I also have a strong backgr
Gisela Ciampi, LCSW
ACCREDITATIONS/CERTIFICATIONS: LICENSED CLINICAL SOCIAL WORKERNJ ALCOHOL AND DRUG COUNSELOR CERTIFICATION (P.I.)CERTIFIED SOCIAL WORK FIELD INSTRUCTORRED CROSS CERTIFIED PARENTING INSTRUCTOREXTENSIVE EDUCATION IN TRAUMA COUNSELINGGISELA CIAMPI graduated from Kean College (NJ) with a Bachelor of Social Work degree in 1981. She completed her masteral education in social work at Rutgers University (NJ) in 1986. She has vast experience in psychothe
Jonathan Stepansky, LPC
Jonathan Stepansky, LPC ACS NCC joined the CJBH team in the fall of 2012 and enjoys working in collaboration with his colleagues treating a diverse population. He has been an active member of the social service and mental-health fie