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      CARE-LA
      Patient Evaluation Forms

      Please click to download or print these fillable PDFs

       
      CARE-LA_Child_Patient_Information_Form_Fillable
      CARE-LA_Child_Patient_Information_Form_Fillable
      CARE-LA_Release_of_Information_Fillable.pdf
      CARE-LA_Release_of_Information_Fillable.pdf
      CARE-LA_Telehealth_Consent_Form_Fillable.pdf
      CARE-LA_Telehealth_Consent_Form_Fillable.pdf
      CARE-LA_HIPAA_Form_Fillable.pdf
      CARE-LA_HIPAA_Form_Fillable.pdf
      CARE-LA_Adult_Patient_Information_Form_Fillable
      CARE-LA_Adult_Patient_Information_Form_Fillable
      CARE-LA_Payment_Authorization_Form_Fillable.pdf
      CARE-LA_Payment_Authorization_Form_Fillable.pdf
      CARE-LA_Covid-19_In-Person_Consent_Form_Fillable.pdf
      CARE-LA_Covid-19_In-Person_Consent_Form_Fillable.pdf
      CARE-LA_Consent_For_Treatment_Fillable.pdf
      CARE-LA_Consent_For_Treatment_Fillable.pdf
      CARE-LA_Email_Communication_Consent_Form
      CARE-LA_Email_Communication_Consent_Form

      CARE-LA

      10323 Santa Monica Blvd. 

      Suites 102, 103 & 106

      Los Angeles, CA 90025

      ​

      Located across from the Westfield Century City Mall

       

      (424) 421-CARE

       

      www.CARE-LA.com

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