Medicare Patient Forms
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.
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
HIPAA Acknowledgment and Notice Form
*Please bring or send a copy of your insurance card(s) and valid identification
Patient Information
Consent for Treatment
Electronic Communication Policy
HIPAA Acknowledgment and Notice Form
*Please bring or send a copy of your insurance card(s) and valid identification
