La Mesa, CA 91942
This form is meant for children under the age of 18 years old. If you are an individual 18 years or older seeking our services, please complete the Adult New Patient Information Form.
IMPORTANT: This form will take you about 15 minutes to complete in its entirety, and you are able to hit “save” and go back to the form if you have not finished it at one time. We appreciate you completing this form as soon as possible so we can start your file. We must receive this form at least 2 days before your first evaluation/session is scheduled, and sooner is preferred. We thank you for your thoroughness in answering these questions in order to enable us to provide you and your child with the best treatment possible!