Client Intake Forms

Download our client contract forms and return them below before your appointment.

Consent for services (docx)

Consent for services Telemedicine Updated 7.2020 (docx)

Consent for services Medication Support (docx)

Consent for services Group Therapy Telemedicine (docx)

Consent for services Couples (docx)

Authorization to release Updated (docx)

Authorization to release form Kaiser Updated (docx)

Credit Card Authorization Form (docx)

HIPAA notice of Privacy English (pdf)

HIPAA_notice_of_privacy_pratices_spanish (pdf)

Disclosure Form (docx)

Contact Us

OUR OFFICE CAN BE REACHED AT 323-879-9176.

AFTER HOURS OFFICE NUMBER: 818-208-1566.

10200 Sepulveda Blvd suite 100, Mission Hills, CA, USA

We are by Appointment ONLY and each staff accommodates services at varied days and times from Monday through Sunday.