Request an Appointment We can’t wait to hear from you!Call (908) 652-5311 or send an email with the form below. Your name: * First Name Last Name What state do you live in? (If your state is not listed, then we are not licensed to provide therapy in your location at this time.) * Alabama Arizona Arkansas Colorado Connecticut Delaware District of Columbia Florida Georgia Idaho Illinois Indiana Kansas Kentucky Maine Maryland Michigan Minnesota Mississippi Missouri Nebraska Nevada New Hampshire New Jersey North Carolina North Dakota Ohio Oklahoma Pennsylvania Rhode Island South Carolina Tennessee Texas Utah Virginia Washington West Virginia Wisconsin Wyoming I am interested in: Individual therapy Couples therapy Family therapy I would like to work with: No preference Lillian Babcock, LPC Theresa Butler, LPC, CAADC, NCC Elizabeth Hahn, LCSW Bonnie Jantzen, LAC Lydia Jordan, LCSW, LCADC Dr. Elizabeth Pearce, PsyD Briefly, what concerns or issues would you like to talk to a therapist about? * Your email address: * The best phone number to reach you: * (###) ### #### May we leave a detailed message when we call this number? (If no, we will leave a general message including the name of the practice and asking for return of our call.) * Yes No What is your preferred way for us to contact you? Email Phone Our therapists are Out of Network with all insurances. We collect session fees at the time of service, and provide a super bill upon request for you to submit to your insurance for possible Out of Network reimbursement. * I understand that I will be responsible for all session fees at the time of service, and that I will submit my own claims to insurance for possible Out of Network reimbursement. Do you have a Medicare plan? * GBH therapists do not participate with Medicare plans. Most therapists at GBH are opted out from Medicare altogether. You will be asked to sign a Medicare waiver and private contract to pay for sessions out of pocket, and will not receive super bills to submit to insurance. Yes, I have a Medicare plan, and understand that I will waive Medicare benefits and enter a private contract for self-pay services at GBH. No, I do not have any type of Medicare plan. Do you have a Medicaid plan? * GBH therapists do not participate with Medicaid. New Jersey Medicaid plans will not reimburse you for any GBH-provided services. *Medicaid laws may vary in other states, and so we do not work with Medicaid beneficiaries outside of New Jersey. Yes, I have a NJ FamilyCare/Medicaid plan and understand that Medicaid will not reimburse me for any session fees. No, I do not have a NJ FamilyCare/Medicaid plan. Yes, I have a Medicaid plan in a state other than New Jersey. Finally, how did you hear about Grace Behavioral Health? * Google/Internet search Psychology Today Focus on the Family AACC/Christian Care Connect TheraVive Directory GoodTherapy Directory Friend or family Another professional (physician, psychiatrist, etc.) Office is convenient/noticed while driving by Other Thank you for getting in touch! We try to respond within 24 hours, excluding weekends and holidays. We look forward to connecting!
