background information, demographic information, insurance/payment option information
848-373-8444
Appointment Request Form
Thank you for considering Breakthrough Therapy Solutions (BTS) to help you on your journey to improved mental health. We try to respond to all requests immediately but no longer than 1 business day.
Important Notes:
Crisis Notice:If you or someone you know is experiencing thoughts of suicide, self-harm, harm to others, or safety concerns, call 911 or contact your local emergency services. For Ocean County Psychiatric Emergency Screening Services (PESS), call (732) 886-4474 or 1-866-904-4474.
This form is for non-crisis outpatient services only. Please use the resources above for immediate assistance.
Once your form is reviewed, we will contact you with the next steps in the process.
TEXT COMMUNICATION CONSENT
We understand that text messages can be a quicker and more convenient way to communicate and many people prefer this method. However, text communication is not fully secure and may pose risks to your privacy.
By consenting (selecting yes in the drop down box below), you acknowledge and accept these risks and agree to receive texts for the sole purpose of confirming receipt of this form and providing updates about next steps. Any detailed communication or follow-up will be sent securely via email.
If you do NOT consent, you may select 'No' in the next box.
INSURANCE POLICY INFORMATION (You may skip this section if you are NOT using insurance)
Thank you for taking the time to complete this form. Upon submission, a member of our team will review your information and contact you. Although we try to contact within the same business day, please allow up to 1 business day for a response. We look forward to speaking with you and discussing the next steps in this process.
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