Belmont Psychological Services
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  • Who we treat
    • Help for Children >
      • Specialties >
        • Obsessive Compulsive Disorder
        • Depression
        • Adult Support Group
        • Parenting Skills Training
        • Substance Use Disorders
    • Help for Couples & Families
    • Help for Defiant Teens
    • Anxiety and Phobias
  • Help for Older Adults
  • Therapists
    • Dr. Katy Manetta
    • Dr. Michelle Beakey
    • Mrs. Nancy Cano
    • Mr. Ben Schwartzman
    • Dr. Haley Murphy
  • Clinical Corner
  • Contact and Location
  • Social Anxiety
  • BPS BLOG
Medicare Patient Forms
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Please select the links below to print and complete the paperwork for your scheduled intake. When you have finished your paperwork, please send it to our office by fax at 562-799-6733 or by mail at the address listed at the bottom of this page.

Teletherapy Consent Form (Medicare)

Patient Information 

Consent for Treatment

Electronic Communication Policy 
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HIPAA Acknowledgment and Notice Form


*Please bring or send a copy of your insurance card(s) and valid identification 



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Belmont Psychological Services

6615 E. Pacific Coast Highway Suite 255
​Long Beach, California 90803
Ph:
562-799-6700 Fax: 562-799-6733
Email: [email protected]
PRIVACY POLICY
© Copyright 2016-2024 ​
​​Belmont Psychological Service
​
​​All rights reserved
  • HOME
  • Who we treat
    • Help for Children >
      • Specialties >
        • Obsessive Compulsive Disorder
        • Depression
        • Adult Support Group
        • Parenting Skills Training
        • Substance Use Disorders
    • Help for Couples & Families
    • Help for Defiant Teens
    • Anxiety and Phobias
  • Help for Older Adults
  • Therapists
    • Dr. Katy Manetta
    • Dr. Michelle Beakey
    • Mrs. Nancy Cano
    • Mr. Ben Schwartzman
    • Dr. Haley Murphy
  • Clinical Corner
  • Contact and Location
  • Social Anxiety
  • BPS BLOG