So Cal Psych Forms
Our office forms are organized below along with brief description of their purpose. Please review and use proper form needed. If you have any questions or in doubt of which form to fill, please feel free to call our office (951)309-2140
New Patient Form for MD Appointment. Every new patient needing Psychiatrist evaluation(/first) appointment for medication.
New Patient Form for Therapist Appointment. Fill this form for your Therapist evaluation(/first) appointment.
Patient Information Update Form Required annually and/or as needed. Use this form to update changes to your contact information, insurance etc. It is very important to keep your updated contact information on file for timely care notifications/access.
Informed Medication Consent This document explains benefits and side effects to watch for with medication(s) prescribed to you. Refer to this document to understand, talk to your doctor during your appointment to ask questions you may have.
Release of Information Form: Use this form to release or obtain treatment information to or from outside So Cal Psych Group, Inc. Must clearly indicate all details required or else the form will not be accepted.
Telemedicine Consent Form needs to be completed only once if you have not compelted in the past. This is to help you understand what is telemedicine and its advantages and limitations.
Established patients, during this crisis period, can also send the following
statement as SMS message using your cell phone on our file to 951-309-2140
I, _____________________________ (PATIENT NAME AND GUARDIAN IF APPLICABLE) understood what is
telemedicine and I consent for telesession with my (OR MY CHILD'S) doctor at Southern California
Psychiatric Group, Inc.
For your reference to complete the consent form, our provider names are listed below
- Dr. B Nallamothu, MD, Diplomate
- Dr. Carol Matthews, PSYD
- Mrs. Melanee Carpenter-Lay, LMFT
- Mrs. Elizabeth Sheppard, LCSW
- Mr. Raymundo Claudio, LMFT
- Mrs. Stephanie Canani, LMFT
- Mr. Terry Porter, LMFT
- Ms. Gayle Sorensen, LCSW
- Ms. Angie Meza, LMFT
- Ms. Mayra Cruz, LMFT
- Mrs. Kathryn Miller, LMFT