Bay Area Health Psychology  

Forms For New Clients

After your first appointment, please complete the first five forms below as best you can.
There are pages in the middle of the forms that require your initials or a check mark. Don't skip these. Be sure to initial and sign the forms where asked to do so.

To open a form, click on the link. Print out the form. And fill it in.
Then scan the completed form into your computer to create a new PDF file.
Do this for each of the five forms.
Attach the new PDF files to an email, and send the email to your therapist, or to Info4BAHP@Gmail.com. You can find your therapist's email address by clicking here to open the Clinician's page.

Some of the forms can be completed online using Adobe. If you do this, you must first save the completed form to your computer before emailing it to your therapist.

You can download Adobe Reader for free by clicking here.

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

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

Consent to Release Information

CONTACT US

Email: Info4BAHP@Gmail.com

Telephone: (650) 999-0220

Fax: (855) 999-0220

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

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

Click to:

Meet our Clinicians

Learn About Client Services

Learn About Provider Services

Learn About CaseKeepers
   
Online Therapy Journal

Install CaseKeepers on Android

Log into CaseKeepers Desktop

Request an Appointment

Request Information

Fees and Insurance

Make a Referral

Featured Article:

How to Choose a Psychotherapist

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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.