Forms
Conveniently located to serve the areas of Culver City and Manhattan Beach, CA
- COVID-19 Facility Protocol for Office Visits
- COVID-19 Precautions
- COVID-19 Patient Notice and Acknowledgement
- HIPAA Practices
- HIPAA Signature Page
- Release Form
- Authorization to Receive Medical Records/Information
- Arbitration Agreement
- Credit Card Authorization
- Financial Policy
- Financial Responsibility Blue Shield Patients
- Child Intake Form
- Adult History Intake Form
- Informed Consent for qEEG and Neurofeedback Training
- Client Neuropathologies Questionnaire
