151 Kalmus Dr, Suite B/220
Costa Mesa, CA 92626
949-675-0545

Cognitive Therapy Orange County

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Office Location
Printable Directions
Map
CTOC Providers
Erik J. Abell, Ph.D.
Gail Simpson, MSW, BCD
Stephen M. Savlov, Ph.D.
Heather Tomilowitz, Ph.D.
Lisa K. Phillips, Ph.D.
CTOC Office Forms
Adult New Patient Forms
Minor New Patient Forms
Other Forms

Frequently Asked Questions

Recommended Reading

Informational Links

Crisis Information

CTOC Office Forms

Below are links to information and policy forms used by Cognitive Therapy Orange County.  Please read and complete all forms in the appropriate New Patient section prior to your appointment. If you have any questions about any of the forms as you are completing them, please write your questions down so you can discuss them with your Provider during your appointment.

The forms are in the Adobe (.pdf) file format. To view/print these files, you will need Adobe Acrobat Reader. If you do not have Adobe Acrobat Reader, you can download a free copy from the Adobe web site.

Adult New Patient Forms

Adult Intake Form

California HIPPA Notice Form

California HIPPA Acknowledgement Form

Outpatient Service Agreement

Child/Minor New Patient Forms

Child/Adolescent Information Form

California HIPPA Notice Form

California HIPPA Acknowledgement Form

Outpatient Service Agreement

Parent/Legal Guardian Consent to Treat Minors Form

Other Forms

Authorization For Release of Information

Authorization To Release Information

Written Directions and Map