Client Forms

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.

Forms - Policy

Forms must be submitted at least 48 hours before your first appointment.  This will allow your therapist to spend as much time as possible focusing on you.

If you don't return your forms 48 hours before your first appointment, your session will be rescheduled.

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 and their approach.

Forms - Privacy

Forms submitted through this website are sent through a HIPAA-compliant system.  Using this system allows us to protect your personal information and confidentiality.  Please submit all forms through the links below.

When minors contact us

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.

Online Forms

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

Your therapist will receive the completed form within 24 hours.

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

General Forms

• 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 Revocation of Authorization Form
• Medicaid Waiver 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

Release of Information Forms for Drug and Alcohol Related Information

• 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