Cognitive Behavioral Therapy Services
Cognitive Behavioral Therapy Services

Patient Forms

New patients will need to fill out several forms before therapy can begin. To make the process as smooth and efficient as possible, we provide the most important documents as downloads right here on our website.

 

Find out which forms you need to submit, select the appropriate download link and return the completed documents to our practice either in person, by fax or as a scanned PDF file via e-mail. Naturally, all forms are also available at the practice; however, filling them out in advance saves time.

If you are unsure which forms to fill out, don't hesitate to contact us.

Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.

Forms to see Chris Tammariello

Patient Rights to Confidentiality
This is for your reference.
HIPAA NOTICE-PATIENT.pdf
Adobe Acrobat document [205.5 KB]
Adult Agreement for Treatment
Advisement form for all adults to complete before their first session.
Adult Advisement.pdf
Adobe Acrobat document [279.6 KB]
Adult Agreement for Treatment- 3rd party pay
For Adults who will be having their sessions paid by another payer.
Adult Advisement3rdpayee.pdf
Adobe Acrobat document [281.0 KB]
Permission for Child to Receive Treatment
Agreement for treatment of a minor.
Child Advisement.pdf
Adobe Acrobat document [106.0 KB]
Additional Agreement for Exposure Treatment
For patients who have been instructed by their therapist to complete
Exposure advisement form.pdf
Adobe Acrobat document [281.1 KB]
Permission to another service provider
This is for all patients who are receiving/ or have received mental health/healthcare from other providers that may be needed to contact by your therapist.
Consent for Release of Informationchecke[...]
Adobe Acrobat document [363.8 KB]
Patient Assessment Form
For all patients (minors and adults) to complete before their first appointment
Patient Intake Questionnaire (PIQ).pdf
Adobe Acrobat document [574.4 KB]
Patient Update
For returning patients
Patient update questionnaire.pdf
Adobe Acrobat document [452.3 KB]

Forms to see Leanna Aubel

Rights of Confidentiality and sharing of information
The reference of the federal law describing patients rights of confidentiality and the handling of information.
HIPAA NOTICE-PATIENT.pdf
Adobe Acrobat document [199.1 KB]
Adult Agreement of Treatment - Self Pay
For all adults who will be paying for their own treatment regardless of insurance.
Adult Advisement.Leanna.A.pdf
Adobe Acrobat document [279.7 KB]
Adult Agreement of Treatment- 3rd Party Payer
For Adults who will be having another person (spouse, parent, or relative) pay for their treatment regardless of insurance.
Adult Advisement3rdpayee.Leanna.A.pdf
Adobe Acrobat document [281.1 KB]
Parent Agreement for treatment of their Child (under 18 years)
Child Advisement.LA.pdf
Adobe Acrobat document [104.5 KB]
Consent to Release of Information
This will allow your therapist to have contact with other treating clinicians to help insure the most effective treatment.
Consent for Release of Information.LA.pd[...]
Adobe Acrobat document [366.4 KB]
Patient Assessment Packet
For all patients to complete before their first meeting with their therapist.
Patient Intake questionnaire.generic.pdf
Adobe Acrobat document [574.4 KB]

Where to Find Us

Cognitive Behavioral Therapy Services
Suite 302
2111 S. El Camino Real
Oceanside , CA 92054
Phone: 760-730-0521 760-730-0521
Fax: 760-730-0581
E-mail Address:

Office Hours

Monday-Friday

8:00 am - 6:30 pm

Saturday Appointments Available

Patient Forms

New patient? Save time and reduce the amount of paperwork you have to fill out at your first visit. We provide several patient forms as PDF downloads on our site.

 

 

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