Client Forms

• Preliminary Verification of Insurance
• Birmingham Maple Clinic Adult Intake Forms
• Birmingham Maple Clinic Child and Adolescent Intake Forms (under 18)
• Birmingham Maple Clinic HIPAA Agreement
• Telehealth Form
• Birmingham Maple Clinic Authorization to Release Information
• COVID Patient Notice and Acknowledgement
• Intake Forms for Psychiatrists
  • Dr. Bradley Klein, Adult Psychiatrist, Intake Forms
  • Dr. Brooke Weingarden, Child and Adolescent Psychiatrist, Intake Forms
  • Dr. Brooke Weingarden, Adult Psychiatrist, Intake Forms
  • Dr. Clark Chen, Adult Psychiatrist, Intake Forms
  • Dr. Clark Chen, Child and Adolescent Psychiatrist, Intake Forms

Surveys

With your candid input we hope to better evaluate the quality and value of our treatment approaches. We are excited by the opportunity to continue to improve our services to you.

• Children Symptom Measure
• Adult Symptom Measure
• Client Satisfaction Survey