Please click on the links below to download the Patient Information Form and Evaluation Forms and complete them prior to the first appointment. I will have extras for you if you forget to bring them or do not have access to a printer; However, filling out the forms during our meeting will mean less time for talking about your situation.

Health History

Initial Telephone Conversation (5-10 minutes)

Please download the following three evaluation forms and bring them to the first appointment

Please download the following two policy forms and bring them to first appointment

(All patients)

Patient Information Form

Note: Please download and bring to the first appointment.

(All patients)

Consent for evaluation and treatment

Note: Please download and bring to the first appointment. You give consent to Dr. Bimbela to receive healthcare/mental health services.

(If applicable)

Authorization to release healthcare information to Dr. Alfredo Bimbela

Note: You give permission to have other professionals and/or agencies release your healthcare/mental health information to Dr. Bimbela.

(If applicable)

Authorization to discuss your healthcare/mental health information with other professionals/people

Note: You consent to have Dr. Bimbela discuss your healthcare/mental health with other people and/or agencies.

(If applicable)

Parental (legal guardian) authorization to evaluate and treat a minor/student

Note: 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.