Please download and fill out the forms (Patient Information Packet) by pressing the link below, you may fax them via our encrypted number (949) 484-8820 or bring them with you to your initial appointment.
If you are unable to download the forms in advance of your session, please plan on arriving 10-15 minutes early to your scheduled initial appointment so that you can fill out the paperwork prior to your first visit.
Your psychiatrist will review these forms and the information you provide at your first visit, as well as answer any additional questions you may have.
This form provides your doctor with more information about you, your reasons for seeking treatment, including consents and authorizations.
Starting January first 2023, please fill out the following Open Payments Database form and submit with your initial packet.
The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov. For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.