(949) 870-7776

8 Corporate Park, Suite 300
Irvine, CA 92606

Forms for New Clients

I wish to have the most time possible during our sessions to hear about your concerns.

Please print, read, and sign in advance the documents below. We will review them during the first session and I will answer any questions you may have at that time. If you are unable to print the documents below, please let me know upon arrival and I will provide you with a copy. Please allow for extra time if you are unable to fill out the forms in advance.

Adults

Consent Form

HIPAA

Client Information Form

Children

Child Development History

These documents are in PDF format and require Adobe Acrobat Reader, which can be downloaded by clicking on this icon.

Have Questions?

If you need assistance with filling out these forms, please contact me so that I may help.  I may be reached by phone or email:

Phone

949-870-7776

Email

drshirink@ymail.com

If you need help, please don’t wait. Contact me today for a no-obligation consultation.

Proudly Serving the Following Communities in Orange County, California

Aliso Viejo
Anaheim
Brea
Buena Park
Costa Mesa
Cypress

Dana Point
Fountain Valley
Fullerton
Garden Grove
Huntington Beach
Irvine

Laguna Beach
Laguna Hills
Laguna Niguel
Laguna Woods
La Habra
Lake Forest

La Palma
Los Alamitos
Mission Viejo
Newport Beach
Orange
Placentia

Rancho Santa Margarita
San Clemente
San Juan Capistrano
Santa Ana
Seal Beach
Stanton

Tustin
Villa Park
Westminster
Yorba Linda

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8 Corporate Park, Suite 300, Irvine, CA 92606