Initial visit Form Packets
You can come prepared by downloading the packet of forms that you are likely to need, printing the pages, and filling them out before you come to your first appointment. Please print the initial visit packets one-sided on your printer.

Initial Visit, under 18, using insurance
Initial Visit, under 18, self-pay only
Client turned age 18

PRior Authorization Form - for Medication
Use this form when requested by SMPA office staff. Fill out the form and email the completed form to smpa@sanmarinopsych.com or FAX it to 626-403-8989. Please also send an image of your insurance card, front and back, in your email or FAX.                   
Prior Authorization Form   

Special Purpose Forms
Print and prepare either of these forms only if you have been requested to do so by one of our staff.
Release to Send Information to outside
Release to Receive Information from outside
Prior Authoization Form

PRIVACY PRACTICES
Privacy Practices of San Marino Psychiatric Associates.

OFFICE
Telephone: 626-403-8999         Fax: 626-403-8989      
Email: smpa@sanmarinopsych.com
HOURS
9:00 am - 6:00 pm - Mon-Thurs, 9:00 am - 5:00 pm Friday - Front Desk
9:00 am - 6:00 pm - Appointment Times, Mon-Fri