Patient Forms

New Patient Forms

If you are a new patient and have been registered online or by phone and directed to this page, please tap the appropriate button below. Completing this prior to your appointment is required. If you have not yet registered with LifeStance Health, please tap to schedule an appointment or call our office (805) 681-0035.

Request to Release Information

To manage the optional transfer of your protected health information, make your request below. 

Form 1: Release Information FROM LifeStance Health

Use this form to authorize the release of your records from LifeStance Health to a third party such as a physician, attorney, school, or for your own records. Also use this form to authorize an individual to schedule appointments on your behalf.

Authorization for Release of Medical or Mental Health Information | En Español

Alternatively, if you are the patient’s guardian:
Form | En Español

Form 2: Release Information TO LifeStance Health

Use this form to authorize a third party such as another individual or doctor’s office to send copies of your records to your LifeStance Health provider.

Authorization for Release of Medical or Mental Health Information | En Español

Alternatively, if you are the patient’s guardian:
Form | En Español

Accepting Financial Responsibility

Form 3: Collateral Services

Use this consent form if your services will not be covered by insurance but you agree to privately pay for clinician services.

Collateral Services Form | En Español

Form 4: Third Party Appointment Scheduling 

If you are willing to guarantee payment for the exceptional situation in which a third party is making an appointment for a patient:

Authorization for Third Party Appointment Scheduling | En Español

Schedule an appointment and start your journey today.