Contact Us – Advanced Psychiatric Associates

We have 3 convenient locations:

211 Essex Street, Suite 204
Hackensack, NJ 07601
(201) 487-1240
Get Directions

Heritage Plaza II
65 Harristown Road
Suite 101
Glen Rock NJ 07452
(201) 487-1240
Directions

256 Columbia Turnpike
North Tower, Suite 209
Florham Park, NJ 07932
(201) 487-1240
Get Directions

Due to COVID-19 we are currently providing most of our services through Telepsychiatry; however, we have on-site physicians and nurse practitioners who can see you face to face at our offices in case you need it or request it. Please fee free to call us to arrange an onsite appointment.

If you would like to inquire about becoming a patient, please complete the following form and we will get back to you as soon as we review it.

New Patient Contact Form

Tittle *

Mr.
Mrs.
Ms.
Dr.

Patient Name *

First

Middle

Last

Is patient a child?

Patient Date of Birth *//

Age

Home Phone: *

Cell Phone: *

Email *

Reason for seeking help *

Select Provider *

Best time to call you

How did you hear from us: *

Name of your Primary Insurance

Name of the Insured Person

Guarantor Date of Birth *//

Insurance Policy Number

Insurance Group Number

Insurance Contact Phone Number

Insurance Card Front (Optional)

Click or drag a file to this area to upload.

Insurance Card Copy

Please take a picture of your insurance card’s front and and upload it here

Insurance Card Back (Optional)

Click or drag a file to this area to upload.

Insurance Card Copy

Please take a picture of your insurance card’s back and and upload it here

Terms and Conditions of Service *

I have read and agree to the terms and conditions

The above information is true to the best of my knowledge. I authorize Advanced Psychiatric Associates to contact my insurance to verify my benefits. Once my benefits are reviewed, APA will contact me.