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Intake Forms

Clinical Associates of Tidewater 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.

 

 

 

New Patient Form (1.21 MB)
New patients must complete this form prior to or at the time of their first appointment.
Social History Questionaire (781.45 kB)
This form must be completed by patients scheduled to see Dr. Mascalo or Dr. Goldblum.
Privacy Notice (52.51 kB)
Clinical Associates of Tidewater Privacy Notice
Provider-Patient Services Agreement/HIPAA Information (1.47 MB)
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.
Acknowledged receipt of HIPAA policies (740.78 kB)
Acknowledge of Receipt of "Notice of Clinical Associates of Tidewater's (CAT) Policies and Practices to Protect the Privacy of Your Health Information"
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Copyright 2011 Clinical Associates of Tidewater
12695 McManus Blvd. Building 8
Newport News, VA 23602