If you are a new patient seeing a therapist at Bucks County Anxiety Center, please fill out the correct client forms and bring them to 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, click here to access a guide by the ACLU.
Patient Intake Forms:
- BCAC New Patient Intake Form
- BCAC Policies and Procedures Form
- BCAC Informed Consent for Phone and Online Therapy
Release of Information Forms:
- BCAC Release of Information Form
- BCAC Release of Information Form – Drug and Alcohol Use Information and Records
- BCAC Release of Information Form – To a Treatment Provider – Drug and Alcohol Information and Records
- BCAC Revocation of Authorization Form
Credit Card Forms:
- BCAC Credit Card Authorization Form – Patient using own card
- BCAC Credit Card Authorization Form – Patient using someone else’s card
Below is a copy of our group’s Privacy/HIPAA statement. Please read this before your first session and sign the HIPAA Acknowledgement/Consent form. You may access this privacy statement at any time.