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New Patient Forms

Hope Psychology Group Inc.

P.O. Box 53633, Irvine, CA, 92619

Tel: (949) 677-5589

Fax: (949) 725-0914

Dear Client:

 

Please go to our website (https://www.hopepsychgroup.com) and fill out Adult or Children office paperwork and/or Adult or children client evaluation (testing) and if you are using EAP, then fill out the EAP Authorization Form.

Please remember:

 

1.    To initial and sign all the forms.

 

2.    If you have insurance, you are only responsible for the copay and/or deductible.

 

3.    You will need to pay the copay/deductible on the day before or same day as your appointment, by using Zell to my phone number 949-677-5589

 

4.    Forms must be back to me before your appointment. Please let me know if you have completed the paperwork and emailed them to me.

 

Thank you

 

Dr. Sahar Teimoori 

P:949-677-5589

F: 949 725-0914

Email: ssteimoor@gmail.com

Mailing address: P.O. Box 53633, Irvine, CA 92619

Adult Intake Form

Click to Fill Out

Child Intake Form

Click to Fill Out

Adult Evaluation Form

Click to Fill Out

Child Evaluation Form

Click to Fill Out

Adult Insurance

Form

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IBH Authorization Form

Click to Fill Out

Patient Release Form

Click to Fill Out

Cash Client Policies

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Adult Insurance

Form

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IBH Authorization Form

Click to Fill Out

Patient Release Form

Click to Fill Out

Cash Client

Policies

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Employee Forms

Best Care Employee Form

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EAP Aetna Form

Click to Fill Out

Anthum EAP Form

Click to Fill Out

Metropolitan
 
EAN Service Agreement

Click to Fill Out

Best Care Employee Form

Click to Fill Out

EAP Aetna Form

Click to Fill Out

Anthem EAP Form

Click to Fill Out

Metropolitan
 
EAN Service Agreement

Click to Fill Out

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