Patient Registration

Thank you for registering online to become a new patient. If you are coming in as a couple, we are requesting that each of you complete the registration process. Please register only after speaking to Dr. Thorpe and an appointment has been scheduled. Providing this information prior to your initial session helps us better focus your appointment time and eliminates errors in entering your information in our system. The security and privacy of your information are very important to us.

1. Click on the link at the bottom of this page and you’ll be directed to a form where you can type in your information. Your cell phone number and e-mail address are required.
2. If you’d like us to submit electronically to your out-of-network benefit coverage, for you to potentially obtain reimbursement, please type in insurance company information. Also, upload the front and back of your insurance card by using the “ID Card” button in the top left.If you are not using any insurance, select the Self Pay check box and again under the Insurance Name drop box.For couples, only upload the insurance information for the partner that you are selecting to be considered the identified patient by your insurance company. All of the appointment information, including a diagnosis, will be submitted under this partner only as per insurance policy.
3. Therapist-Patient Agreement: Please read and sign the last page of this document. If you’re coming in with someone 14 years of age or older, have them sign as well. When we meet, I’ll explain this document in detail. If you’d like a copy, please click on this link.
4. Since we may be meeting via Zoom, please read and sign the Internet Therapy Consent Form.
5. Payment is due at the time services are rendered. Accepted methods of payment are: checks, cash or credit cards (Amex, VISA, MasterCard and Discover). If using a credit card, permission to hold your credit card on file is requested and the card will be charged when services are carried out.Please provide your credit card information by filling out this form. If you are not paying by this means please opt out and provide your signature for the registration process to continue. Under the amount, please write in “open for up to $350/hour”.Note: All appointments are typically 45 minutes, at a rate of $250/individuals and $275/couples and families. Initial consultation is $300/individuals and $325/couples and families. Any additional work requested by you or required on your behalf, for all therapy patients, will be billed at a prorated hourly rate of $350.
6. Good Faith Estimate: Please indicate whether this process applies to you or not and if so familiarize yourself with the details in the document.
   The No Surprises Act prevents patients from receiving surprise medical bills. Under the law, health care providers are required to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items or services called a Good Faith Estimate. This does not apply to patients who use their out-of-network insurance benefits for reimbursement. (Dr. Thorpe is an out-of-network provider for all insurance plans.) If this does not apply to you, please opt out and provide your signature for the process to continue.
7. New Jersey Notice: Notice of Policies and Practices to Protect the Privacy of Your Health Information. Please read it if you like by clicking on this link.
8. When you come in, you may want to fill out an Authorization for Release Form: If you’re working with a psychiatrist or other healthcare professional with whom you’d like me to coordinate care. We will discuss this in person.

Address/Parking/Building – click on this link

This registration form should be completed only upon Dr. Thorpe’s instruction.

You will receive Registration Submitted Successfully if your info went through.
To ensure this please hit Save & Continue for all of the forms, even if you are not signing them and turn off your pop up blocker so that you get error messages directing you to fill out needed information.