Client Forms

Welcome! The luna centre is now using DocuSign to complete new Client Forms. As part of your Initial Intake,  please follow the steps that apply to you. By clicking the links, you will be directed to DocuSign to complete the required forms. Please complete all forms before your initial appointment.

*DocuSign is free, does not store or share information with third parties and you do not need to create an account to complete your forms.

Release of Information

Credit Card Authorization

CalVCB Health Form

CalVCB Insurance Form

Medical Lien Form

GAD-7

General Anxiety Measure

BDI-2

Beck Depression Inventory 

PHQ-9

Patient Health Questionnaire-9

ESS

Epworth Sleepiness Scale

DSM-5 Child/Parent Scale

Screen for Child Anxiety

Ages 6-16 SDQ Form

Level-2 -Dep-Parent/Guardian-Child Age 6-17