Street Address: 2140 41st Avenue, Suite 200B, Capitola, CA 95010
Main Telephone Number: (321) 208-1554

              Office Manager Telephone Number: 321-298-8668
              E-Mail Address:
              Fax Number: (831) 325-0125

Psych Evaluation Test Forms Details


UCSC Students: Dr. Chambers does not take your insurance. However, you will receive a check for all services he provides to you after you pay the contracted rate in full. Those interested in the details should contact our offices. This does require a large out of pocket expense that will be refunded to you by Anthem Blue Cross within 3-6 Weeks.

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FORMS for ALL Patients:

Informed Consent Testing 8.29.16 (Required for a Psych Evaluation Test)

Telemed Informed Consent 6.25.15 (Telelmed Informed Consent)

HIPAA Word Final 5.9.15 (Required Psych Evaluation Test)

Intake Form 5.15.15 (Optional, HIGHLY Suggested for Children)

Authorization of Release 6.25.15 (For all Releases of Information)

UCSC HARDSHIP LETTER 6.25.15 (For Students Needing Financial Help From the School) *You will need the funds prior to the appointment. It usually takes about 2 weeks.


  • An intervention for nonsuicidal self-injury in young adults: A pilot randomized controlled trial. April 17, 2017
    Objective: Nonsuicidal self-injury (NSSI) is prevalent among young adults and associated with negative medical and psychological consequences, necessitating its treatment. However, few treatments have been developed to treat NSSI specifically, or to treat the behavior among individuals without borderline personality disorder. The purpose of this study was to investigate the Treatment for Self-Injurious Behaviors (T-SIB), […]
    Andover, Margaret S.; Schatten, Heather T.; Morris, Blair W.; Holman, Caroline S.; Miller, Ivan W.
  • How much is enough? Examining frequency criteria for NSSI disorder in adolescent inpatients. April 17, 2017
    Objective: To empirically evaluate the diagnostic relevance of the proposed Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; APA, 2013) Criterion-A frequency threshold for nonsuicidal self-injury (NSSI) disorder. Method: Archival, de-identified, self-reported clinical assessment data from 746 adolescent psychiatric patients (Mage = 14.97; 88% female; 76% White) were used. The sample was randomly […]
    Muehlenkamp, Jennifer J.; Brausch, Amy M.; Washburn, Jason J.
  • Mechanisms of change in cognitive therapy for major depressive disorder in the community mental health setting. April 13, 2017
    Objective: This study examined the relation of change in theory-relevant cognitive variables to depressive symptom change over the course of cognitive therapy, as well as the specificity of change mechanisms to cognitive therapy as compared with dynamic therapy. Method: There were 237 adult outpatients who were randomized to either cognitive (n = 119) or dynamic […]
    Crits-Christoph, Paul; Gallop, Robert; Diehl, Caroline K.; Yin, Seohyun; Gibbons, Mary Beth Connolly

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  Content Copyright 2014. All Rights Reserved: Gerard Chambers Psy.D., Ph.D. -- 2140 41st Avenue, Suite 200B, Capitola, CA 95010 -- Phone: (321) 208-1554