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. Find 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/tampabayReturnUrl=%2FPortal%2Ftampabay%2FMain%2FHandledError

Below are the forms we need you to read, print, complete and/or sign prior to your initial consultation appointment.   

NOTE:  For Telehealth Sessions, these forms MUST be received prior to the consultation session or the appointment will need to be rescheduled.

You can open them from here, or from the portal.  They are “fill-in” forms so just fill them in, save and email to us.  If coming into the office and you want to fill them in on paper,  come 15 minutes earlier than your appointment time and you can complete 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  OR you can take a picture of the forms, or scan them and email to our HIPAA compliant email at admin@tbcforcbt.com

 

TBCforCBTRegistrationForm

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 and one for the credit cardholder if it is not the client)

Credit Card Authorization Form

Confidentiality Agreement

Informed Consent for Telehealth Services

If you are coming into the office for in-person sessions please read and sign: TBC Informed consent for clients coming back to the office.

For Families joining the Family Education and Support Program:  Burden Assessment Scale

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

If you will be receiving Group-only services at our center, in addition to the above forms, here are a few other forms you will need to read/complete:

Group-Only Primary Provider Crisis Plan fill-in (To be completed by your outside Primary Provider)

Group-Only Individual Crisis Plan fill-in (To be completed by you and your group-only intake therapist)

Skills Group only Welcome Letter (Please thoroughly read this information about our Group-only services and expectations)

Here are some other DBT forms and documents that will be reviewed and discussed as your therapy progresses:  (You don’t need to sign now)

After-hours phone coachingGroup-Only Crisis Plan fill-in

DBT Therapy Contract

Outpatient chain analysis     

Blank diary cards

After Hours Phone CoachingGroup-Only Primary Provider Crisis Plan fill-in

Guidelines for Skills Training