Intake Form

Intake Forms

Thank you for trusting us with your healthcare needs, we look forward to meeting you, and we hope to exceed your expectations in every aspect of your behavioral treatment. Each employee at Pasadena Clinical Group is committed to enhance the quality of your care and your overall experience. Filling out the form below will help us get acquainted with your medical history and your needs. Complete the form below in each part to the best of your knowledge, it will help your therapist to target your plan. 

You will need to a have a copy of your Driver's License (or any other government issued ID), and a copy of your insurance card. 

Should you have any questions, please do not hesitate to contact our office for help at 626-354-6440, Monday through Friday, from 8 am to 7 pm.