CAPS
133 South 36th Street, 2nd floor
Philadelphia, PA 19104
Tel: (215) 898-7021
Fax: (215) 573-8966
caps@pobox.upenn.edu

We are located in the Mellon Building, across the street from the Bookstore. The entrance is on 36th Street, across from Cosi.

Vice Provost for University Life

Intake Forms Packet
Below are the contents of the Intake Forms Packet, which we ask you to download (.doc), print, complete, and sign before you come to your intake appointment:

Treatment Consent: Required in order to provide treatment, please read and sign.
Face Sheet: Main information form we need in order to give you an appointment. Please sign.
Research Consent Form: You are not required to consent to research, but if you do consent, please sign this form.
Initial Questionnaire: Questions regarding how you are feeling.
Weekly Schedule: Diagram to show us when you are free during the week.

Other Foms
Return from Medical Leave of Absence Packet
If you want to return from medical leave, download this packet and follow the instructions.

Release of Information Form
If you would like CAPS to release information about your treatment here, to yourself or anyone else, please complete and return the signed original to our office.

CAPS Forms

The Counseling Forms are some of the forms which we require in order to offer you our services during your initial "intake" appointment.

When you come in for your intake appointment, you will be asked to complete a few more forms which must be done just before seeing a clinician. It's always best to come a few minutes early for your appointment to get these forms done.

Please complete, print, and sign as appropriate all Intake Forms and bring them with you to your intake appointment.

Also included are often-requested forms for returning from leave or for sharing information about you with others.