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Welcome — Let's Get You Started

Complete the forms below at your own pace. You can save and return to finish later.

Please note: Submitting these forms does not initiate care or establish a doctor-patient relationship. After you've completed the forms below, our team will review your submission and reach out to schedule an initial visit.

Please complete the four forms below to become a new patient at California Center for Behavioral Health. Each form takes a few minutes. Once all are submitted, our team will reach out to schedule your first visit.

Required for New Patients
01

Intake Questionnaire

Patient information, medical history, current medications, symptoms, and personal history.

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02

Agreement of Care

Appointment policies, missed appointment fee, billing and payment responsibilities.

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03

Telemedicine Consent

Required if you'll be seen via video visit. California residents only.

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04

Privacy Practices Acknowledgment

Confirms you've received our Notice of Privacy Practices.

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Optional / As Needed
05

SMS Consent Optional

Authorize us to send appointment reminders, refill notifications, and care-related messages via text.

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06

Release of Information If requesting records

Authorize us to share your health information with another provider, family member, or agency.

Open Form →
Prefer paper forms? You can still download and fax or bring printed copies to your visit.

Intake · Care Agreement · Telemedicine · Release of Info · Notice of Privacy Practices · Privacy Acknowledgment