Forms

Psychotherapy Forms

Adults

Initial Evaluation – Adults (Document: DrCB-2022-Initial-Evaluation-Adults)

Confidentiality, Fees, Insurance, and Consent – Adults (Document: DrCB-2022-Confidentiality-Fees-InsuranceConsent-ADULTS)

Medicare & Blue Cross, Insurance, Fees, Confidentiality & Consent

Medicare Opt-Out, Insurance, Fees, Confidentiality & Consent

Substance Use Checklist

Collateral Intake Supplement- Adult (Document: DrCB-2022-CollateralIntakeSupplement-of-an-Adult)

Authorization of Use of Digital Communication

Credit Card Authorization

Curriculum Vitae

Minors

Initial Evaluation – Minors (Document: DrCB_2019_Initial Evaluation – Minors)

Confidentiality, Fees, Insurance, and Consent – Minors (Document:DrCB_2019_Confidentiality_Fees_Insurance_Consent – Minors)

Collateral Intake Supplement-Minor (Document: DrCB_2019_Collateral Intake Supplement (of a Minor))

Relationship Counseling Forms

Initial Evaluation-Relationship Counseling (Document: DrCB_2019_Initial Evaluation_Relationship Counseling)

Confidentiality, Fees, Insurance, and Consent – Adults (Document: DrCB_2019_Confidentiality_Fees_Insurance_Consent – Adults)

Forensic Evaluation Forms

Substance Use

Substance Use Evaluation Form (Document: Dr_CB_2019_Substance Abuse Evaluations_Format_Custody Eval)

Substance Abuse Initial Evaluation (Document: DrCB_2019_Eval_Sub_Abuse_Initial Evaluation)

Substance Use Evaluation Confidentiality & Fees (Document: DrCB_2019_Eval_Substance Use_Confidentiality & Fees)

Credit Card Authorization on File (Document: Dr_CB_2019_Credit Card Authorization on file)

Sexual Behavior

Forensic Sexual Behavioral Evaluation (Document: DrCB_2019_Forensic Sexual Behavioral Evaluation)

Initial Evaluation – Adults (Document: DrCB_2019_Initial Evaluation – Adults)

Sexual Behavior_Confidentiality & Fees (Document: DrCB 2019_Eval_Sexual Behavior_Confidentiality & Fees)

Credit Card Authorization on File (Document: Dr_CB_2019_Credit Card Authorization on file)

Collaborative Divorce Forms

Collaborative Divorce Info Sheet (Document: CCLLC 2019_Collaborative Divorce Info Sheet)

Collaborative Agreement (Document: DrCB_2019_Collaborative Agreement)

Collaborative Divorce Marital History Questionnaire (Document: COLLAB DIVORCE_Marital_History_Quest)

Credit Card Authorization on File (Document: Dr_CB_2019_Credit Card Authorization on file)

Miscellaneous Documents

Authorization of Use of Digital Communication (Document: DrCB_2019_Authorization of Use of Digital Communication)

Substance Abuse Checklist (Document: DrCB_2019 Brief Substance Abuse Checklist)

Credit Card Authorization on File (Document: Dr_CB_2019_Credit Card Authorization on file)

Curriculum Vitae – Dr. Christopher Barrilleaux (Document: Curriculum Vitae_October 2019)