Here you will find all outpatient documents that you will need to begin treatment services and additional documents that you may need throughout the course of treatment.

Please download and complete the following forms and bring them with you to your first appointment. If you have any questions about the forms, please do not hesitate to call or email. If you have any difficulty downloading these forms, they can be emailed to you at your request. These forms will be reviewed at the beginning of your initial appointment.

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​New Patient Forms: Obtains information about your medical history and background information.

 

Patient Financial Responsibility Agreement: Authorized credit card form to keep on file necesssary to begin services.

 

Notice of Privacy Practices: For your records, explains your rights and how your protected health information (PHI) will be used.

 

Outpatient Services Contract: Contains information about the scope of treatment, office policies, fees, and consent for treatment.

 

Authorization for Release of Protected Health Information: Authorizes release of protected health information (PHI) to other providers, professionals, and/or family members for coordination of care and to aid in your treatment.

 

Expert Witness Testimony Retainer Agreement for Services: Agreement and contract for retaining expert witness testimony services.

 

Teletherapy Services Agreement: Agreement and consent for teletherapy or "telehealth" services to be furnished via a HIPAA compliant electronic platform.

 

Credit Card Authorization Form: This form collects and authorizes credit card charges to be made for services rendered and for other fees that arise throughout the course of treatment.

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Collateral Service Agreement: Provides information about what a "collateral" is and allows you to invite a spouse, family member, or significant other to participate in treatment.

 

Parking Instructions:           Newport Beach          Los Angeles

Map providing location of free 2-hour visitor parking. LBH will not validate parking.

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Psychological Testing Contract: Contains information about psychological testing services, office policies, fees, and consent for testing services.

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Outpatient Psychiatry Services Contract: Contains information about the scope of psychiatric treatment, office policies, fees, and consent for treatment.

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Psychoeducational Testing Information Packet: Provides information about what psychoeducational testing is and how it can help in the academic setting.

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