Providing Psychological Healthcare Since 1983

Psychologist Intake FormsWe at Clinical Associates of Tidewater want to make things as convenient as possible for you. On this page you will find a variety of forms that we encourage you to download and complete prior to your first appointment.  Please bring these completed forms with you. The secretaries will give them to your therapist in preparation for your session.

 

Acknowledged receipt of HIPAA policies

Intake Form PDF

Acknowledge of Receipt of “Notice of Clinical Associates of Tidewater’s (CAT) Policies and Practices to Protect the Privacy of Your Health Information”


Clark Intake Form

Intake Form PDF

New patients must complete this form prior to or at the time of their first appointment with Dr. Clark.


New Patient Form

Intake Form PDF

New patients must complete this form prior to or at the time of their first appointment.


Privacy Notice

Intake Form PDF

Clinical Associates of Tidewater Privacy Notice


Provider-Patient Services Agreement/HIPAA Information

Intake Form PDF

This document contains important information about our professional services and business practices, and must be read and signed prior to or at the time of your first appointment.  Any questions you may have about this information can be addressed with your provider at the time of service.


Social History Questionaire (Adult, Rev 3-2013)

Intake Form PDF

This form must be completed by new (adult) patients scheduled to see Dr. Anderson, Dr. Goldblum, or Dr. Mascalo.