If you are a new patient, please complete the following forms and bring them to your initial evaluation. You can fill out the forms on your computer (simply click on the blank line to activate the text box; you will need Adobe Acrobat DC to create a digital signature) or print them out for completion or signing.

Patient Information
Treatment Consent
HIPAA Notice of Privacy Practices (you only need to complete the last page)

If you would like me to coordinate care with another provider (for example, your therapist or primary-care physician), please complete this form to authorize release of information:

Release of Information

If you have Medicare, please be aware that I have "opted out" of Medicare. If you wish to receive treatment from me and have Medicare, you will need to read and to sign the following letter prior to your first visit.

Medicare Opt-Out Acknowledgement Letter

1800 Fairburn Avenue
Suite 211
Los Angeles, CA 90025
(818) 277-9414