New Patient Forms

If you are a new patient please download the files below.

Instructions for use:

  1. Email a picture of the front and back of your insurance card together with the patient name and date of birth. In the subject line include your last name and birthdate.
    Send to: sandra@flatonaddeptcenter.com, cc: drflaton@flatonaddeptcenter.com

  2. 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.

  3. Please download all files below

    1. Print each of the files

    2. Complete front and back of each document, and initial all lines on the Agreement & Consent form

    3. Please scan the completed forms and return them to us via fax

    4. Once we have received the completed forms, we will contact you within two business days to schedule an appointment

For College Students and Patients 18 years of age and older, having Another Party Responsible for Payment:

For Student to Complete (And For Financially Responsible Party to Review:):

For Financially Responsible Party to Complete:

For Patients, 18 years of age and older:

For Teen Patients, ages 13-17:

For Children, ages 12 and under:

Please prepare for each session by having those rating scales completely filled out ahead of time that Dr. Flaton asks for:

  1. CD

  2. CESD-C

  3. CESD

  4. D3A

  5. D3

  6. D4

  7. D5

  8. D6

  9. GAD-7

  10. ODD

 

Rating Scales:

Flaton ADDept Center

Janet Flaton, M.D., F.A.A.P.

San Luis Obispo, CA 93401

phone: (805) 545-8500

fax:  (805) 465-6135