Mandatory Forms to Read and Complete Before Your First Appointment:

1) New Patient Information Form (scroll down and complete below) or Click This Link
2) Privacy Practices and Contract for Services (read only)
3) Privacy Practices and Contract Signature Page (print and sign)
4) California Notice to Consumer (read only)
5) Adolescent Consent and Parent Privacy Agreement (For parents of clients under age 18; print and sign)
6) Psychological Assistant Informed Consent (For working with Dr. Mariella Lauriola; print and sign) 
                         
                        

Optional/Additional Forms:

You may email any of the above documents to Fred@drfred.net if you prefer. If you are unable to print, I will have a copy of the Privacy Practices Signature page for you to sign but you must read it first.

 

Our office is no longer going to be accepting insurance as payment (except for Anthem Blue Cross of California).

You may still use your insurance and we will assist you with a super bill for submission to your insurance company for direct reimbursement.

We will request that you pay for services at the time of your appointment. Please see the Fees page for detailed information.