11770 Warner Ave. Suite 121, Fountain Valley, CA. 92708 • Phone: 714-486-1778
Children, Adolescents, Adults
11770 Warner Ave. Suite 121
Fountain Valley, CA. 92708
Please download and fill out the
New Patient information Form Part 1 [download]
and New Patient Information Form Part 2 [download]
and bring them with you to the office.
Please also download the HIPPA Privacy Form.
Consent for Telepsychology
NOTE: Initial the last page of this form and bring that page with you to your appointment. This documents only that you were given the form.
"I wanted to tell you a long overdue and heartfelt thank you for helping me. I remember you as being the only adult that understood me and at that time that meant the world to me".
"You have given me the tools to be happy and successful in my life and I am now using them!"
"Thank you for all of your help and patience in our son's recovery process. The good news is that he is now getting straight A's in his classes and working 20 hours a week. Things are going well and he is his old self again! We are thrilled with his progress. Thank you again."
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