New Patients

Advance Health Care Directive Form

Acknowledgement of Advice for Advance Health Care Directive (English)  (Spanish)

Caregiver/Appointed Representative Form (English)   (Spanish)

Consent for Treatment and Patient Financial Responsibility Form (English)   (Spanish)

No Show Policy (English and Spanish)

Notice of Privacy Practices (English)    (Spanish)

Patient Information (English)   (Spanish)

Sliding Fee Discount Schedule - 2024 (English and Spanish)

Sliding Fee Discount Application (English)   (Spanish)

New Patients

Caregiver/Appointed Representative Form (English)   (Spanish)

Consent for Treatment and Patient Financial Responsibility Form (English)   (Spanish)

No Show Policy (English and Spanish)

Notice of Privacy Practices (English)    (Spanish)

Patient Information - Pediatrics (English)   (Spanish)

Sliding Fee Discount Schedule - 2024 (English and Spanish)

Sliding Fee Discount Application (English)   (Spanish)

Existing Patients

Release of Medical Information (English)   (Spanish)

New Patients

Advance Health Care Directive Form

Caregiver/Appointed Representative Form (English)   (Spanish)

Consent for Treatment and Patient Financial Responsibility Form (English)   (Spanish)

Health History Form - Adult (English)   (Spanish)

Health History Form - Pediatric (English)    (Spanish)

Notice of Privacy Practices (English)    (Spanish)

Patient Information (English)    (Spanish)

Sliding Fee Discount Schedule - 2024 (English and Spanish)

Sliding Fee Discount Application (English)    (Spanish)

New Patients

Advance Health Care Directive Form

Caregiver/Appointed Representative Form (English)   (Spanish)

Authorization for Behavioral Health and PCP to Share Confidential Information Form (English)    (Spanish)

Behavioral Health Office Policy and Consent for Treatment (English)    (Spanish)

Consent for Treatment and Patient Financial Responsibility Form (English)    (Spanish)

Consumer Information (English)    (Spanish)

No Show Policy (English and Spanish)

Notice to Psychotherapy Clients

Notice of Privacy Practices (English)   (Spanish)

Patient Information (English)     (Spanish)

Psychotropic Medication Consent

Sliding Fee Discount Schedule - 2024 (English and Spanish)

Sliding Fee Discount Application (English)    (Spanish)

Text Message Opt-In Form

CPCA Patient Handout

Patient Complaint or Comment Form (English and Spanish)

Release of Medical Information (English)    (Spanish)

Staff Recognition (English)    (Spanish)