Vermont Center for Anxiety Care
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Additional Intake Forms - 
​Carolyn Balparda

Adult Intake Forms

billing and registration form
Patient Policy Form
patient privacy notice
patient privacy acknowledgement
teletherapy consent form
Email/text policy & consent
professional disclosure
BILLING UPDATE FORM
CREDIT CARD FORM

Child & Adolescent Intake Forms

child info & developmental history
billing and registration form
patient policy form
Patient Privacy Notice
patient privacy acknowledgement
teletherapy consent form
Email/text policy & consent
professional disclosure
BILLING UPDATE FORM
CREDIT CARD FORM
Vermont Center for Anxiety Care (Affiliated with Otter Creek Associates) • 112 Lake St., Burlington, VT 05401 • Tel: 802-865-3450 ext. 480 • Fax: 802-859-3309
  • Home
  • Vermont Center for Anxiety Care
    • About the Vermont Center for Anxiety Care >
      • Our Therapists
    • Our Therapists
    • Professional Opportunities
    • Continuing Education
  • New Patient Intake Forms
  • Books and Products
  • Dr. Paul Foxman
  • Speaking Engagements
    • Upcoming Speaking Engagements
    • Workshop Topics
    • Testimonials
  • Contact