New Clients
Welcome! Let's Talk Today
To avoid problems with insurance verification, please complete your New Client Information at least 3 days before your first appointment — online, by email, or by fax.
Three Ways to Submit
Pick whichever is easiest for you. Whichever way you choose, your information stays confidential and protected.
Submit Online
Your information is submitted through a secure, HIPAA-compliant service. Data is encrypted to ensure confidentiality. Open the form, fill in the requested information, and make sure to hit submit.
Open New Client Information ↗Submit by Email
Prefer email? Send your New Client Information to our secure, HIPAA-compliant address — data is encrypted to ensure confidentiality. Not sure where to start? The online form above is the easiest way.
recoverynow@hipaamail.usSubmit by Fax
Prefer fax? Send your New Client Information to our secure fax line, or use the online form above.
Fax (888) 345-6044Please note
Payment will be due at the time of service if we do not receive your New Client Information form at least 72 hours before your first appointment. Thank you for your cooperation — we look forward to meeting you.
Questions? Call us at (310) 957-2099 or request an appointment online.
