TBC for CBT uses an electronic medical record called Valant which has a “Patient Portal”.  When you are scheduled for the initial consultation appointment, you will get an email with a link to the portal and instructions on how to set it up.  PLEASE SAVE THIS LINK AND YOUR USERNAME AND PASSWORD.  This portal allows you to:

  1. Print out client registration paperwork and view other practice policies.
  2. Update or change demographic information
  3. Email your therapist confidentially under HIPAA guidelines.  (NOT to be used for crisis or urgent messages; please call your therapist)
  4. Obtain “Superbills”, Statements and balances.
  5. Complete assessments as assigned by your therapist

HERE IS THE LINK FOR THE PORTAL: 

https://valantmed.com/Portal/tampabay?ReturnUrl=%2FPortal%2Ftampabay%2FMain%2FHandledError

Below are the forms we need you to read, print, complete and sign prior to your consultation appointment:  You can print them from here, from the portal or come 15 minutes early and you can fill them out in the office.  If you are engaging in Telehealth Services, please fax these forms to 813-651-4402 or mail them to PO Box 14, Brandon, FL.  33509. As of 5/25/20 you can take a picture of the forms, or scan them and email to our new HIPAA compliant email at admin@tbcforcbt.com

HIPAA Disclosure  (This document is for you to review, you will sign on the New Client registration form for receipt of this document)

New Client registration

Release of Information (Please fill out one for your emergency contact, one for each person you want us to have contact with to collaborate on care)

Credit Card Authorization Form

Confidentiality Agreement

Informed Consent for Telehealth Services

Group Telehealth Consent

Here are some other DBT forms and documents that will be discussed as your therapy progresses:

After-hours phone coaching

DBT Therapy Contract

Outpatient chain analysis

Blank diary cards