Download Consent Form and Release of Information Forms
 

Consent Forms

 

 

Consent for evaluation and treatment (Adults)

Please download and bring to the first appointment.

 

 

Parental or legal guardian authorization (under 18 years of age)

You consent to have Dr. Bimbela provide healthcare/mental health services to someone who is under the age of 18 years of age and considered a minor by Calfornia law.

Permission to release and discuss your information

 

 

Authorization for Dr. Bimbela and others to exchange your information.

You give permission to Dr. Bimbela and others to exchange your healthcare/mental health information.