JUSTIN LAPILUSA, PSY.D.
  • Home
  • Therapy
  • Forensic
  • Demeanor Management
  • Dr. LaPilusa
    • Dr. Lapilusa in the Media
  • Resources
    • Clinic Forms
    • Help & Resources
    • Handouts and Worksheets
  • Contact
  • Fitness for Duty

Clinic Forms

Picture

English

HIPPA Privacy Notice
File Size: 36 kb
File Type: docx
Download File

Spanish

Aviso de Practicas de Privacidad (HIPPA Privacy Notice)
File Size: 60 kb
File Type: docx
Download File

Informed Consent
File Size: 44 kb
File Type: docx
Download File

Consentimiento Informado (Informed Consent)
File Size: 73 kb
File Type: docx
Download File

Client Intake
File Size: 40 kb
File Type: docx
Download File

Cuestionario de Admision Psicologica (New Client Intake)
File Size: 87 kb
File Type: docx
Download File

Informed Consent - Telehealth
File Size: 114 kb
File Type: docx
Download File

Consentimiento Informado de Telesalud (Informed Consent - Telehealth)
File Size: 115 kb
File Type: docx
Download File

Client Intake - Workers Compensation
File Size: 66 kb
File Type: docx
Download File

​No Surprises Act Clause

Under the No Surprises Act law, you have the right to receive a "Good Faith Estimate.” This law ensures that cash-pay clients know how much their medical and mental health care will cost. You have the right to ask your healthcare provider for a Good Faith Estimate before you schedule a service, and to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.

Contact

619-400-9894
Click here to send us a message!

Join Us on Social Media!

Credentials


​​Justin LaPilusa, Psy.D., Q.M.E.

Clinical/Forensic Psychologist
​PSY25187
​
Qualified Medical Evaluator 
#147963
Picture

Check out our Blog Articles!
Location
16959 Bernardo Center Drive
Suite 110
​San Diego, CA 92128
  • Home
  • Therapy
  • Forensic
  • Demeanor Management
  • Dr. LaPilusa
    • Dr. Lapilusa in the Media
  • Resources
    • Clinic Forms
    • Help & Resources
    • Handouts and Worksheets
  • Contact
  • Fitness for Duty