Client Forms:

Forms updated as of 05/25/2020

Credit Card Agreement

Acknowledgment of Forms

Sliding Scale Application Form

Release of Information

Consent for Treatment

Telehealth Consent Form

Emergency Release Form

Notice of Privacy Practices

Emergency Contact for Telehealth

Infectious Disease Informed Consent

Substance Abuse Contract

Lenny Gallo, LCSW, LCADC, LMT, ACT

3 Overhill Rd.
Verona, NJ 07044

Phone: 973-559-3669

Fax: 973-692-7784

Contact Me:

© 2020 by Lenny Gallo, LCSW, LCADC, LMT, ACT.

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