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) and then print them out for signing.

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.   

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:

Note: All forms are PDF files.  To download Adobe Acrobat Reader for free, click here.

16430 Ventura Boulevard
Suite 307
Encino, CA 91436
(818) 277-9414

1849 Sawtelle Boulevard
Suite 650
Los Angeles, CA 90025

Phone:  (818) 277-9414


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