Please Complete the appropriate form(s) before your first appointment.

Some forms can be downloaded, other can only be completed online. Online submission is the fastest way. If you choose to download and complete your form offline please type in clearly and sign legibly, so your insurance claims are not denied. Also, do not leave any question unanswered: if there is a question that does not apply to your case add NA and explain why it does not apply to you. Once you have filled out the form make a copy for your records, and bring the original with you. Due to the HIPAA (federal) laws we do not accept any form sent by email. If you have any question you can contact us at (626) 354-6440, Mon - Fri 9am - 5pm.


Form # Form Name Who must sign it? ONLINE SUBMISSION DOWNLOAD
ADULT 013A  Informed Consent Patient NO NO
015A Notice of Privacy Policy  Patient NO NO
017A Office Policies Patient NO NO
019A Arbitration Agreement Patient NO NO
021A HIPPA Receipt Patient NO NO
023A Psychological Tests  Patient NO NO
025A Neuropsychological Test  Patient NO NO
027A Authorization to disclose Patient NO NO
029A Structured Developmental Questionnaire P