Search Behavioral Health Intake Forms

Forms & Documents > Behavioral Health Intake Forms

Name Description
Acknowledgement-of-Notice-of-Privacy-Practices English_2-27-18

Acknowledgement of Notice of Privacy Practices
Acknowledgement-of-Notice-of-Privacy-Practices Spanish_2-27-18

Reconocimiento de Noticia de Practicas Privadas
Health_Questionnaire_Spanish

Health_Questionnaire_Spanish
Health_Questionnaire

Health_Questionnaire
Notice-of-Privacy-Practices_English_1-18-19

Notice of Privacy Practices
Notice-of-Privacy-Practices_Spanish

Aviso de Practicas de Privacidad

Please contact our access line at 1 (800) 838-1381 for information or to schedule an appointment. All services are available in Spanish.

Licensed by the State Department of Health Care Services.