Bay Area Health Psychology  

Forms For New Clients

After your first appointment, please complete the following three forms as best you can. Be sure to initial and sign the forms where asked to do so.

Click on a link to open a form. You can fill in the form online, then print it to a PDF and email the PDF file to

Or you can download a form, print it out, fill it in, and scan it to create a PDF file and email the PDF file to

If you are using Chrome, the form will open as a fillable form. If you are not using Chrome, you will need a PDF viewer such as Adobe Reader to view the forms. You can download Adobe Reader for free by clicking here.

New Patient Intake Questionnaire
Notice of HIPAA Privacy Practices
Treatment Authorization and Agreement
FCAP: Functional Capacity Assessment Profile
Informed Consent for Telepsychology

Please use the following form if you are asked to complete and sign a Consent to Release Information form:

Consent to Release Information



Telephone: (650) 999-0220

Fax: (855) 999-0220

Services offered via telepsych:
Zoom, FaceTime, WhatsApp, GoToMeeting, Google Meet, MS Teams

Our mailing address:
3860 West Naughton Ave.
Belmont, CA 94002

Click to:

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Learn About Patient Services

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Learn About CaseKeepers
Online Therapy Journal

Install CaseKeepers on Android

Log into CaseKeepers Desktop

Request an Appointment

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Fees and Insurance

Make a Referral

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This website is for informational purposes only. Information offered in this website does not constitute a professional relationship, advice, or service with or from Bay Area Health Psychology, its providers or affiliates.