All paperwork may be faxed to the office at 562-431-3200,
sent by mail to P.O. Box 1405, Los Alamitos, CA, 90720,
or brought in to your next session.
New Client Paperwork
This paperwork will provide you with a more detailed understanding of the therapy process, my practice policies and other considerations (late cancellation/no show policies, emergency contact information, social media guidelines, etc). It also contains legal documents including the consent for treatment, a review of confidentiality laws, and federally required HIPPA notice.
Please print out and complete prior to your first appointment in order to maximize our face-to-face time together. If you have any questions or concerns, make note of the area on the paperwork, and do not sign that area. Bring the completed document with you to our first appointment. If you have any questions, please call me at 562-293-3095 or we can discuss your questions further when we meet.
Authorizations for Release of Information
By completing this form, you are authorizing me to give and/or receive information about your therapy to individuals and/or organizations with whom you specify. Please complete all information and return it to the office as soon as possible.
Change of Information Form
Please complete this form if any of your contact, billing, or medication information changes and return it to the office as soon as possible.
This document provides instruction on how you access recommended assessment and session evaluation tools in Clinical Documents and Monitoring sections of the Carepath’s system. Assessments are billed according to your contract agreement. Please see New Client Paperwork for pricing.