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Home » Contact Us

Contact Us

Address:
Jewish Family Services of Greenwich
One Holly Hill Lane
Greenwich, CT 06830

Office Hours:
Monday – Thursday: 9:00 am – 5:00 pm
Friday: 9:00 am – 4:00 pm
Evening Hours by appointment

Contact:
Phone: 203-622-1881
Fax: 203-622-1885
Email: [email protected]

Please complete the following form if you are interested in counseling or support groups

Name
First Last
Name of Guardian (if client under 18)
First Last
Email
Phone
Address
Date of Birth
If minor, current school attending
Insurance Company
Insurance Policy #
Secondary Insurance Company (if applicable)
Secondary Insurance Policy #
Emergency Contact Name
Emergency Contact Number
Have you ever been in therapy before?
- Yes
- No
If yes, please explain
Are you currently seeing a psychiatrist for medication management?
- Yes
- No
If so, who?
Is this for a court order or forensic related matter?
- Yes
- No
Have you been hospitalized in the last 3 months?
- Yes
- No
If yes, please explain
Do you own a firearm?
- Yes
- No
Have you thought about harming yourself?
- Yes
- No
Have you thought about harming others?
- Yes
- No
If yes, please explain
Do you have any active substance abuse concerns, or sobriety for less than 3 months?
- Yes
- No
If yes, please explain
Please briefly explain the reason for your visit
CAPTCHA

Upcoming Events

May 27, 2020 7:00pm

Book Beat- The Diamond Setter

July 8, 2020 7:00pm

Book Beat- Wild Card

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Jewish Family Services of Greenwich
One Holly Hill Lane,
Greenwich, CT 06830
(203) 622-1881

About
Programs & Services
Volunteer
Events
Contact Us
Donate

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About
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Events
Contact Us
Donate

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