MelrosePsych Forms

You may download and use these forms to save time before your appointment with Dr. Baltz. If you are a tele-health client, please make sure to return the forms to him or his assistant. The initial paperwork, which includes a consent for treatment, needs to be filled out, initialed, signed, and returned before your appointment.

Required Forms

Initial Intake Form

Initial Intake Form

All new clients must initial, sign, date, and return this form.

Optional Forms

Adult ADHD Self Report Scale

ASRS (Adult ADHD Self Report Scale)

For clients with problems sustaining focus and completing tasks.

MelrosePsych
8060 Melrose Ave, Suite 200, Los Angeles, CA 90046