New Patient Forms
To ensure smooth coordination and save time during your visit, please review and download the appropriate forms below. In compliance with Privia Health policies, these link directly to the latest official documents.
Privia Care Center Forms
Please review and click the links below to access the latest direct PDF downloads from Privia Health.
Notice of Privacy Practices (PDF)
Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
Download DocumentAuthorization for Release of Medical Information (PDF)
Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
Download DocumentAuthorization and Consent for Treatment (PDF)
Autorización y Consentimiento Para el TratamientoAll patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility.
Download DocumentPreferred Contacts (PDF)
Contactos PreferidosPatients are encouraged to complete and return the Preferred Contacts Form but it is not required.
Download DocumentFinancial Policy (PDF)
This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
Download DocumentLanguage Services
Language assistance services, free of charge, are available to you. Notice of Nondiscrimination / Servicios de asistencia lingüística.
View NoticePatient Forms — Common Questions
What forms do I need to complete before my first appointment?
New patients should review and complete the Notice of Privacy Practices, Authorization and Consent for Treatment, and Financial Policy forms available on this page. Completing these in advance helps your first visit run smoothly.
Do I need to bring anything else to my first visit?
Bring a valid photo ID, your insurance card, a list of current medications, and any relevant prior psychiatric records if available. This helps your provider build an accurate picture of your history from the start.
Are the patient forms available in Spanish?
Yes. The Preferred Contacts and Authorization and Consent for Treatment forms are available in Spanish (Contactos Preferidos and Autorización y Consentimiento Para el Tratamiento).
How do I submit my completed forms?
Forms can typically be completed and submitted through the Privia Patient Portal, or brought with you to your appointment. If you're unsure how to submit a specific form, call (210) 352-5200 and our front desk can guide you.
What if I have questions about the Financial Policy or billing?
Our administrative team, including Practice Manager Desiree Newsome, can answer billing and financial policy questions. Call (210) 352-5200 or use the contact form to reach our billing team directly.
Ready to Get Started?
Schedule a comprehensive psychiatric evaluation at any of our four San Antonio area locations.
Health 210 Psychiatry is a proud member of Privia Medical Group — a high-performance physician network committed to coordinated, patient-first care across San Antonio and beyond.
