Patient Forms 

Please choose the appropriate category below and follow the links to print and complete the paperwork for your scheduled assessment. 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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Online & Phone Therapy Consent Forms

Teletherapy Consent Form (Medicare)
Teletherapy Consent Form (All Others)

Adult New Patient Forms

Patient Information 
Consent for Treatment 
Electronic Communication Policy 
HIPAA Acknowledgement and Notice Form

Child & Adolescent New Patient Forms

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

Medicare New Patient Forms 

Patient Information 
Consent for Treatment
Electronic Communication Policy 
​HIPAA Acknowledgment and Notice Form
Please bring a copy of your insurance card(s) and valid identification