Schedule intake appointment

(Please complete form)

First Name
Last Name
Please enter a valid phone number.
[email protected]
Please Select
  • Child 6-11
  • Teen 12-18
  • Adult 19 and up
  • No elements found. Consider changing the search query.
  • List is empty.
Please Select
  • Yes
  • No
  • No elements found. Consider changing the search query.
  • List is empty.
Please Choose
  • Family / Friends
  • Google
  • Community Event
  • Social Media
  • Church
  • School
  • Other
  • No elements found. Consider changing the search query.
  • List is empty.

SELF PAY IS $135 per session

Sliding scale available

Please Choose
  • Self Pay
  • Self Pay / Sliding Scale (need additional info)
  • Use My Insurance
  • No elements found. Consider changing the search query.
  • List is empty.

Insurance Verification

Please Select
  • Aetna
  • United Health Care
  • Employee Assistance Program
  • BC/BS NJ
  • Oxford
  • Cigna
  • Oscar Health
  • BC.BS Massachusetts
  • Optum Health
  • No elements found. Consider changing the search query.
  • List is empty.

I Consent to Receive SMS Notifications, Alerts for appointments & Occasional updates on services from Healing Quest Counseling Villages. Message frequency varies. Message & data rates may apply. Text HELP to 856.605.7332 for assistance. You can reply STOP to unsubscribe at any time.