New Patient Forms
If you are a new patient please download the files below.
Instructions for use:
Text Dr. Flaton at 805-545-8500 to let her know it has been sent. She will contact you once the biller has reviewed your insurance information.
Please download all files below
Print each of the files
Complete front and back of each document, and initial all lines on the Agreement & Consent form
Please scan the completed forms and return them to us via fax
Once we have received the completed forms, we will contact you within two business days to schedule an appointment
For College Students (with another party responsible for payment):
Forms For Student:
To Be Filled Out By Financially Responsible Party:
For Patients, 18 years of age and older:
For Patients, under 18 years of age:
Please prepare for each session by having those rating scales completely filled out ahead of time that Dr. Flaton asks for:
NOTE: This section is work in progress. All forms are being updated. In the meantime, please accept our apologies for the low visual quality of the forms.