Contact | Ascend Behavioral Wellness

Phone

Mon–Fri, 9:00 AM – 5:00 PM

Email

General: info@ascendbehavioralwellness.com
Intake: intake@ascendbehavioralwellness.com
Referrals: referrals@ascendbehavioralwellness.com

Service Area

New Jersey / Virtual Services

Telehealth services throughout New Jersey

Online Forms

How Can We Help?

Select the form that best matches your inquiry. We respond within 1–2 business days.

General Inquiry

Have a question about our practice, services, or policies? Send us a message and we'll get back to you promptly.

Full Name *

Email *

Phone

Subject *

Message *

This form is not for emergencies. For crisis support, call or text 988.

Client Intake Request

Ready to begin services? Complete this form and our intake team will contact you to discuss next steps.

First Name *

Last Name *

Email *

Phone *

Date of Birth

Service Requested *

Preferred Contact Method

Insurance Provider

Brief Description of Your Needs

For intake inquiries, you may also email intake@ascendbehavioralwellness.com. By submitting, you consent to be contacted by Ascend Behavioral Wellness. This form is not monitored 24/7.

Referral Partner Form

Submit a referral for a client. Please ensure you have appropriate authorization to share client information.

Your Organization *

Your Name & Title *

Your Phone *

Your Email *

Client First Name *

Client Last Name *

Client Date of Birth

Client / Guardian Phone

Service Requested *

Urgency Level

Reason for Referral

By submitting, you confirm appropriate consent or authorization exists to share this information.

Contact Us

Phone

Email

Service Area

How Can We Help?

General Inquiry

Client Intake Request

Referral Partner Form