New Patients

Acknowledgment of Receipt Notice of Privacy Practices
Acknowledgment of Receipt Notice of Privacy Practices (Spanish)
Medical Release
Medical Release (Spanish) 
Notice of Privacy Practices
Notice of Privacy Practices (Spanish)
Patient Information - Adults
Patient Information - Adults (Spanish)
Patient Financial Responsibility Form
Patient Financial Responsibility Form (Spanish)
Sliding Fee Discount Schedule - 2022
Sliding Fee Discount Application
Sliding Fee Discount Application (Spanish)

Existing Patients

Medical Release 
Medical Release (Spanish)

New Patients

Acknowledgment of Receipt Notice of Privacy Practices
Acknowledgment of Receipt Notice of Privacy Practices (Spanish)
Authorization Caregiver-Guardian
Authorization Caregiver-Guardian (Spanish)
Medical Release 
Medical Release (Spanish) 
Notice of Privacy Practices
Notice of Privacy Practices (Spanish)
Patient Information - Pediatrics
Patient Information - Pediatrics (Spanish)
Patient Financial Responsibility Form
Patient Financial Responsibility Form (Spanish)
Sliding Fee Discount Schedule - 2022
Sliding Fee Discount Application
Sliding Fee Discount Application (Spanish)

Existing Patients

Medical Release
Medical Release (Spanish)

New Patients

Acknowledgment of Receipt Notice of Privacy Practices
Acknowledgment of Receipt Notice of Privacy Practices (Spanish)
Authorization for Caregiver/Guardian (English and Spanish)
Health History Form - Adult
Health History Form - Adult (Spanish)
Health History Form - Pediatric
Health History Form - Pediatric (Spanish)
Medical Release 
Medical Release (Spanish) 
Notice of Privacy Practices
Notice of Privacy Practices (Spanish)
Patient Information
Patient Information (Spanish)
Patient Financial Responsibility Form
Patient Financial Responsibility Form (Spanish)
Sliding Fee Discount Schedule - 2022
Sliding Fee Discount Application
Sliding Fee Discount Application (Spanish)

New Patients

Acknowledgment of Receipt Notice of Privacy Practices Form
Acknowlegement of Receipt Notice of Privacy Practices Form (Spanish)
Authorization for Behavioral Health and PCP to Share Confidential Information Form
Authorization for Behavioral Health and PCP to Share Confidential Information Form (Spanish)
Behavioral Health Office Policy and Consent for Treatment
Behavioral Health Office Policy and Consent for Treatment (Spanish)
Consumer Information
Consumer Information (Spanish)
Notice to Clients
Notice of Privacy Practices Form
Notice of Privacy Practices Form (Spanish)
Patient Financial Responsibility Form
Patient Financial Responsibility Form (Spanish)
Patient Information
Psychotropic Medication Consent
Sliding Fee Discount Schedule - 2022
Sliding Fee Discount Application
Sliding Fee Discount Application (Spanish)

Text Message Opt-In Form

CPCA Patient Handout
Patient Grievance Form  (English)   (Spanish)

Staff Recognition
Staff Recognition (Spanish)