Please allow extra time during your first visit to fill out these forms.
Client Registration
If you are an adult , please fill out this form and bring it to the first appointment.
Adult Questionnaire
Please fill out the Adult History Form and bring it to the first appointment.
Consent for Treatment
All clients must fill out this form and bring it with them to their first appointment.
Payment Authorization
All clients must fill out this form and bring it with them to their first appointment.
HIPAA Notification
Your rights under the Health Information Portability and Accountability Act
HIPAA Agreement
Download and sign the HIPAA Agreement after reading the HIPAA Form
Release of Information
Authorization for release of Mental Health, Alcohol & Drug Abuse and other personal health information
Email Waiver
Election to receive unsecure text or email communications from BBHW.
Consent for Teletherapy
Complete the “Telepsychological Services” checklist if you intend to take part in teletherapy sessions
No Surprises Letter
Download this letter to learn our responsibilty to you under the No Surprises Act.
Good Faith Estimate
Download this form for your reference and your therapist will discuss this with you.
Estimate Fee Schedule
Download this reference table of fees for service. Number of sessions TBD with your clinician.
Private Pay Contract
If you intend to pay “Out Of Pocket” (fee for service), download this form and complete it and remit it to BBHW prior to your next appointment.
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Contact us today to schedule your first appointment!