Child, Adolescent & Adult Psychologist

Dr. Charles E. Gutierrez, Ph.D.

Child/Adolescent Patient Forms

Attached you will find the child/adolescent new patient forms. We realize the new patient paperwork process is lengthy and time consuming, so please complete these forms prior to your visit, to help reduce your wait time. When you invest your time to thoroughly complete all the forms, it will allow Dr. Gutierrez to provide you a better diagnosis. Patients who complete their paperwork first, will be seen first. For your convenience, we have provided you two ways to complete these forms:

1) Print forms to complete by hand and bring to your appointment.

2) Complete forms online, print a copy and bring to your appointment.

Patients who complete their paperwork first,

will be seen first.