Rise Up Counseling

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Forms

  • For intake and client forms including releases,
    please email: admin@riseupcounseling.net
    or call/text us at 201-677-5801

  • Contact us by email, phone call or text for patient portal access and other related support. All inquiries will be addressed within 48 business hours.

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Release form below

Release of Protected Medical Information

I hereby authorize Rise Up Counseling (RUC) to speak with the person or group listed above regarding my protected medical information. I also understand that I may revoke this release at any time by writing to admin@riseupcounseling.net.
Drop your file here or click here to upload You can upload up to 1 files.

This release will become invalid one year after the date is signed.

Our goal at Rise Up Counseling is to provide accessible, quality care for all.  Our services include individual, group, couples and family counseling as well as assessments- treating grief, trauma, OCD, Neurodivergence and Veterans/First responders. 

Address: 9 S Main St, Marlboro NJ 

Call or text: 201-677-5801

Email: admin@riseupcounseling.net

 
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