24-hr Crisis Lines:
855.278.4204 (Santa Clara) |
650.579.0350 (San Mateo) |
415.781.0500 (San Francisco) |
800.273.8255 or Text BAY to 741-741 (National)
CHC during Shelter in Place: Services are available!
Learn more
or call 650.688.3625
Español 650.688.3650
Forms
First Appointment Forms
Please complete the following forms for a first appointment:
English:
- Registration Form
- Email Authorization Form
- Consent for Treatment Form
- HIPAA Privacy Notice
- Authorization to Exchange Confidential Information
Spanish:
- Registration Form (Spanish)
- Email Authorization Form (Spanish)
- Consent for Treatment Form (Spanish)
- HIPAA Privacy Notice (Spanish)
- Authorization to Exchange Confidential Information (Spanish)
Financial Aid Forms
To apply for financial aid, please complete this form:
Para solicitar ayuda financiera, por favor complete este formulario:
