Dr. Michele Lob PsyD. MFT Eating Disorders & Addictions, Child & Family Therapy

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Michele Lob, Psy.D, MFT
(949) 350-4194
drmichele.lob@gmail.com
New Client Forms

If you're a first-time client, please review and complete the following forms, and bring them to your first session.

  • Individual Intake Form
  • Informed Consent
  • Notice of Privacy
  • Client Billing Letter
  • Electronic Payment Form

If you would like to coordinate care with another provider (for example, your psychiatrist, endocrinologist, etc.), complete this form:

  • Consent to Release Information Form

 


Electronic Payment Form
Notice of Privacy
Individual Intake Form
Client Billing Letter

Note: To download Adobe Acrobat Reader for free, click here.


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