CNS New Patient Forms

The following online forms are required before scheduling an intake appointment. They will allow your doctor to spend time during your initial appointment focusing on important clinical issues rather than logistical.

CNS New Patient Enrollment Form

• There are 2 components to enrollment:
  • 1. Click here for Online Registration
  • 2. Click here for Psychological Testing

 

• Psychological testing is ordinarily done as an extra cost, but is included in the intake fee at CNS Health
• After submission, the CNS site will conduct a pre-authorization to the credit card on file. Please note that the funds are not charged, but are simply reserved.
• When we have received your paperwork, our staff will call you to schedule an initial appointment.
• Please note that our re-scheduling & cancellation policy requires 48 business hours advanced notice, 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 1-2 days before the appointment.
• If you have problems completing the forms online, you may click to download a PDF paper version. This can be completed by hand and mailed or faxed into 310-440-9810.