Gulf Coast Behavioral Clinic
Gulf Coast Behavioral Clinic
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    • Home
    • Contact
    • Patient Portal
    • Telemed
    • Forms
    • Make A Payment
  • Home
  • Contact
  • Patient Portal
  • Telemed
  • Forms
  • Make A Payment

Forms

  • All NEW PATIENTS must complete the New Patient Welcome Packet, the New Patient Questionnaire (adult or child), and the Cross-Cutting Assessment prior to the initial appointment, or the appointment might have to be rescheduled.  Please note that there is an Adult (ages 18+) and Child (ages 6 - 17) Questionnaire so please ensure that the correct form is filled out.  


  • ALL PATIENTS should fill out the PHQ (adult or adolescent), the GAD-7, and the Mood Disorder Questionnaire for every visit. Please note that there is an Adult (ages 18+) PHQ and an adolescent(ages 11 - 17) PHQ so please insure that the correct form is filled out. Also note that both versions of the PHQ are bundled with the GAD-7.   


  • PATIENTS that have not been seen in 6 months or longer need to fill out the Welcome Packet and Past Medical History.

GCB Clinic Authorization to Release Medical Records Form (pdf)Download
GCB Clinic New Patient Welcome Packet with Forms (pdf)Download
GCB Clinic New Patient Questionnaire-Adult (pdf)Download
GCB Clinic New Patient Questionnaire-Child (pdf)Download
Telemed Consent Form-pdf (pdf)Download
DSM-5 Cross-Cutting Symptom Measure—Adult (pdf)Download
DSM-5 Parent/Guardian-Cross Cutting Symptom Measure- Child Ages 6-10 (pdf)Download
DSM-5-TR Cross-Cutting Symptom Measure - Child Ages 11-17 (pdf)Download
PHQ-9 (18+) and GAD-7 Form (pdf)Download
PHQ-A (11-17) and GAD-7 Form (pdf)Download
The Mood Disorder Questionaire (pdf)Download
Past Medical History (pdf)Download
Wender Utah Rating Scale(WURS) (pdf)Download
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Gulf Coast Behavioral Clinic

3126 Rodd Field Road, Corpus Christi, TX 78414, US

Phone: (361) 452-6898 Fax: (361) 452-6870

Copyright © 2018 Gulf Coast Behavioral Clinic - All Rights Reserved.

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