office (510)
770-6005
The following forms are needed to satisfy legal and privacy concerns:
Adult Intake Form - Please complete this and bring to first session, for adults.
HIPAA Privacy Information: Please read before signing HIPAA Consent Form.
HIPAA Consent Form: Required by law to sign regarding privacy.
Consent to Release Information Form: Signed form required to release/share information.
Telepsychiatry Consent Form - Consent Form to allow consultations using phone / Skype
Out-of-Network Reimbursment Checklist - Checklist to determine estimate of insurance reimbursement