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New Client Forms
New Client Paperwork–The CBPS New Client Packet is required for all new clients. It provides information regarding our services and rates, as well as directions to the office. After completing and signing, e-mail the form to email@example.com, fax it to 877-643-0126, or bring it to your first appointment.
Telehealth Addendum–Required for clients seeking teletherapy services. The client or guardian should complete, sign, and email this form to us at firstname.lastname@example.org (or by fax, mail, or in person).
Telehealth Instructions–Follow these instructions prior to your first teletherapy session. Print or same this information for your own use.
Authorization to Release Information–To authorize the release of information to or from CBPS, a client or guardian may complete, print, sign, and return this form.
CBPS Credit Card Agreement–To authorize CBPS to charge a credit card each time a balance is due on the account, the cardholder may complete, print, sign, and return this form.
CBPS Guarantor Fee Agreement–If someone who did not sign the original Fee Agreement wishes to take responsibility for payment, that person may complete, print, sign, and return this form.
CBPS Discount Application for Families–For clients or families unable to pay our customary fees, an adult family member may use this form to apply for a discount based upon income and family size. (Approved discounts are applied to future services only.)