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Working at the Beach

Printable Forms

Below you will find a list of our printable forms.  Office forms include information regarding services, Privacy/HIPAA, the use of Technology, and Office Policies.  These forms can be printed and stored for your records.  Clients forms are printable versions of the documents required to be completed by all new clients. If you have opted out of submitting your intake forms electronically, you can print the necessary forms from the comfort of your home and bring them in completed for your first session.

Office Information Forms

Telehealth and Technology Informed Consent *Required*

Office Policies Form *Required*
Privacy Notice *Required*
Informed Consent *Required*
Psychiatry Informed Consent *Required*

Printable Client Forms

General & Insurance Information

ALL NEW CLIENTS

Adult Intake Form

Adult Clients 18 & Over

Child/Adolescent Intake

Clients 17 & Under

Psychiatry Intake Form

All Psychiatry Patients (Dr. Fernald)

Agreement Signature Form

ALL NEW CLIENTS

Credit Card Authorization Form

ALL NEW CLIENTS

IF YOU HAVE CHOSEN TO PRINT COPIES OF THE INTAKE PAPERWORK TO BE COMPLETED PRIOR TO YOUR APPOINTMENT, PLEASE READ ALL OF THE OFFICE INFORMATION FORMS.  ALL CLIENTS MUST SUBMIT THE FOLLOWING FORMS:  GENERAL & INSURANCE INFORMATION, APPLICABLE INTAKE FORM, AGREEMENT SIGNATURE FORM, AND CREDIT CARD AUTHORIZATION FORM.

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