The following forms can be downloaded for your convenience. All forms are in PDF format and require Adobe Acrobat Reader, which may already be included in your browser. Please call us if you have any questions completing the forms (310) 276-4003. Forms can be faxed to (310) 276-4073 or emailed to email@example.com.
Patient Eval Forms
Adolescent Intake Forms – For children under 18 years of age.
Treatment Of A Minor – Authorization from parent or legal guardian.
Consent For Psychotherapy – For patients that will be coming in for therapy.
Other Office Forms
Credit Card Authorization – For a credit card to be on file for payments.
Release For Financial Data – For an additional responsible party paying for the appointments.
Insurance Verification – Necessary information needed to verify medical benefits and properly submit claims.
Release of Information for Medical Data – Authorization for any medical information to be released to an individual, agency, company, or institution.