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Client’s Downloadable Documentation Forms

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Insurance Form

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Permission to Treat Minors

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Patient Consent Form

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Notice of Privacy Practice

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Cancellation Form

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Coordination of Care

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Telemedicine Form

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Credit Card Form

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Child and Adolescent History

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Releaser of Information

Quick Links

  • Home
  • Services
  • Therapists
  • Client Forms
  • Insurance
  • About
  • Contact

Therapists

Andres J. Pintaluga

Jonathan Pintaluga

Alina Fluxa-Cutie

Shirley Leader

Contact Info

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954-894-1174

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Andres@cpcshollywood.com

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5124 Hollywood Blvd Hollywood, Fl 33021

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