Client Forms

If you are a new patient seeing a therapist at Bucks County Anxiety Center, please fill out and submit the correct client forms before your first session.

This will allow your therapist to spend as much time as possible focusing on you.

All therapists who practice at Bucks County Anxiety Center use the same general forms and have the same policies and procedures.

Your therapist may ask you to complete extra forms or assessments based on your needs.

Please note, in the state of Pennsylvania, minors ages 14 and up may seek out and receive mental health treatment without parental consent.

For more information about minors seeking medical and mental health care, you can read this guide by the ACLU.


Please fill out and submit online forms unless your therapist tells you to do something different.  Thank you. 


Online Forms:

Please click on the link for the form you need. Once you fill it out, please hit submit.

Your therapist will receive the completed form within 24 hours.

BCAC New Patient Intake Form + HIPAA Form

BCAC Policies and Procedures Form

BCAC Informed Consent for Phone and Online Therapy

BCAC Credit Card Authorization Form

BCAC Release of Information Form


BCAC HIPAA (Patient Privacy) Policy 

Below is a copy of the HIPAA/Privacy statement.

Please read this before your first session and sign the HIPAA Acknowledgement/Consent form that is part of the New Patient Intake.

You can access this privacy statement at any time.

BCAC HIPAA/Privacy Policy


Please only fill out the PDF versions of our forms (see below) if you are instructed to do so by your therapist. 

Other Forms (PDF):