• banner image

    Patient Portal

    Current patients click here to access the portal

    We are currently using a secure patient portal for all of our forms.

    Please look for an email from [email protected] for access to the secure patient portal.

    Once you confirm your appointment by email, you will receive access to the secure patient portal where all the forms can be found, some of which may be completed online. Please look for an email from [email protected] which will provide information on how to access the portal.

    Should you have difficulty accessing the portal or prefer to complete the forms and email or fax them back to us, they are all provided below. We prefer for you to upload these forms to your portal, but you may email forms to [email protected] or fax to 858-400-5204 at least 24 hours prior to your appointment..

    All New Patients

    New Patients Must Complete Forms (1-6) below, as well as the appropriate history form, and upload them to you secure portal (or email/ fax) prior to your appointment. Once you confirm your appointment you will receive an email allowing access to your portal. All of these forms will be there.

    *Please note: all these forms are also available in the secure patient portal

    1. Patient Information (PDF)

    2. Practice Guidelines (PDF)

    3. Privacy Statement (PDF)

    4. Email and Social Media Communication (PDF)

    5. Credit Authorization(PDF)

    6. Telehealth Consent Form(PDF)

    Children/Teens

    If A Child/Teen Is To Be Seen, Parent/Guardian Please Complete One History Below:

    Teen (13-18) Please Complete This Self-History:

    Young Adults (18-23)

    If a Young Adult (18-23) Is To Be Seen In Therapy, Please Complete:

    Release of Information Form

    To Give Permission For Dr. Rappaport To Speak With Someone Regarding You Or Your Child/Teen, Please Complete The Release Of Information Below.