CNS Patient Forms

Patient Forms | CNS Integrated Behavioral Health & Medicine


Please take the time to fill out the necessary forms online before scheduling an appointment. Simply click on the links below to access a particular form.

If you are unsure as to which form(s) to fill out, please call our office at 310-440-9800 to talk with a CNS Specialist.


CNS New Patient Enrollment Form

  • Before scheduling an appointment with one of our CNS Specialists each patient is required to complete the initial Registration Paperwork.  The forms can all be completed online and include information regarding the patient/provider agreement, privacy policies, fees, and asks questions related to the patients current reason for seeking our services and a review of medical history.  This information is extremely helpful for the CNS Specialists to have beforehand, which allows for a more thorough and comprehensive assessment.
  • Registration Process:
    • Please read & complete each page carefully before  initialing at the bottom.
    • Please also printthe completed forms and bring them with you to your appointment.
    • After your paperwork has been submitted, our billing department will conduct a pre-authorization to the credit card on file. Please note that the funds are not charged, but are simply verified.
    • When we have received your paperwork, our staff will call you to schedule an initial assessment appointment. 
    • Please note that our re-scheduling and cancellation policy includes a necessary advanced notice of 48 business hours, otherwise the regular appointment fee will be assessed.
    • Although payment for appointments is usually due at the time of service, for the initial evaluation the credit card will sometimes be charged the day before the appointment.
  • If you have problems completing the forms online, click here to download them and complete them by hand. Fax completed forms back to 310-440-9810. You may also mail or email them. If you have difficulty with the above link, you may have to Right-click on it and select “Download” or “Save” it onto your desktop, and print from there.


Patient Testimonial Form

  • Provide your own personal experiences of recovery!  We would like you to share this experience with others so that those in need of mental health care may also benefit. The CNS Specialists appreciate your candid responses and willingness to share your thoughts, words, experiences, and images of your treatment with others.