Private Pay Patient Forms
Please choose the appropriate category below and follow the links 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 choose the appropriate category below and follow the links 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.
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Forms for Children and Adolescents
Patient Information Consent for Treatment Child Therapy Contract Adolescent Consent Form (Only for patients between the ages of 13-17) Electronic Communication Policy HIPAA Acknowledgement and Notice Form |
