KIRA STEIN, MD, APC

ADULT PSYCHIATRY - BOARD CERTIFIED ABPN


Helpful Forms

 

 

INDIVIDUAL FORMS:

 

FORMS FOR FINANCIAL GUARANTORS

  • These forms are to be used if patients have a guarantor paying for their services. Guarantors should FAX completed forms to 888-959-0148 at least 48 business days before the patient's initial visit.  Patients need to make sure they complete the authorization to release billing information to the guarantor, also found in the initial paperwork.

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

TEL 310.529.6051

FAX 888-959-0148