Intake Forms

New Client Intake



  • Brett Peppe, MA, LPC, LCADC
    BP Therapy at Brett Peppe, LLC
    Phone: (908) 248-2762
    E-mail: [email protected]
    Website: www.bp-therapy.com
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Below you will find a list of common challenges people face. Please check any that apply to you at present.
  • Type your full name
  • Date Format: MM slash DD slash YYYY

Informed Consent



  • Brett Peppe, MA, LPC, LCADC
    BP Therapy at Brett Peppe, LLC
    Phone: (908) 248-2762
    E-mail: [email protected]
    Website: www.bp-therapy.com
  • Date Format: MM slash DD slash YYYY
  • Type your full name
  • Date Format: MM slash DD slash YYYY

Notice of Privacy Practices - HIPAA



  • Brett Peppe, MA, LPC, LCADC
    BP Therapy at Brett Peppe, LLC
    Phone: (908) 248-2762
    E-mail: [email protected]
    Website: www.bp-therapy.com
  • Date Format: MM slash DD slash YYYY
  • Type your full name
  • Date Format: MM slash DD slash YYYY

Telehealth Informed Consent



  • Brett Peppe, MA, LPC, LCADC
    BP Therapy at Brett Peppe, LLC
    Phone: (908) 248-2762
    E-mail: [email protected]
    Website: www.bp-therapy.com
  • Date Format: MM slash DD slash YYYY
  • Type your full name
  • Date Format: MM slash DD slash YYYY

Patient Health Questionnaire-9



  • Brett Peppe, MA, LPC, LCADC
    BP Therapy at Brett Peppe, LLC
    Phone: (908) 248-2762
    E-mail: [email protected]
    Website: www.bp-therapy.com
  • Date Format: MM slash DD slash YYYY
  • Type your full name
  • Date Format: MM slash DD slash YYYY

Release of Information



  • Brett Peppe, MA, LPC, LCADC
    BP Therapy at Brett Peppe, LLC
    Phone: (908) 248-2762
    E-mail: [email protected]
    Website: www.bp-therapy.com
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Type your full name
  • Date Format: MM slash DD slash YYYY

Patient Health Questionnaire-9A



  • Brett Peppe, MA, LPC, LCADC
    BP Therapy at Brett Peppe, LLC
    Phone: (908) 248-2762
    E-mail: [email protected]
    Website: www.bp-therapy.com
  • Date Format: MM slash DD slash YYYY
  • Type your full name
  • Date Format: MM slash DD slash YYYY

ACEs Questionnaire



  • Brett Peppe, MA, LPC, LCADC
    BP Therapy at Brett Peppe, LLC
    Phone: (908) 248-2762
    E-mail: [email protected]
    Website: www.bp-therapy.com
  • Date Format: MM slash DD slash YYYY

  • Prior to your 18th birthday:
  • Type your full name
  • Date Format: MM slash DD slash YYYY

Youth Outcome Measure



  • Brett Peppe, MA, LPC, LCADC
    BP Therapy at Brett Peppe, LLC
    Phone: (908) 248-2762
    E-mail: [email protected]
    Website: www.bp-therapy.com
  • Date Format: MM slash DD slash YYYY
  • Type your full name
  • Date Format: MM slash DD slash YYYY