Shopping Cart
Your Cart is Empty
Quantity:
Subtotal
Taxes
Shipping
Total
There was an error with PayPalClick here to try again
CelebrateThank you for your business!You should be receiving an order confirmation from Paypal shortly.Exit Shopping Cart

BART ROSS, Ph.D., PSYCHOLOGIST 

Licensed Clinical Psychologist

Certified EMDR Therapist


Over 40 Years in Clinical Practice

323.791.1808

INDIVIDUAL

TRAUMA

ANXIETY

PTSD


NEW PATIENT INFORMATION

INSURANCE VERIFICATION

  1. Name:

  2. Address:

  3. Phone Number:

  4. Date of Birth:

  5. Gender:

  6. Picture of insurance card (front and back)

  7. Picture of drivers license

PLEASE FORWARD THE INFORMATION TO MY EMAIL ADDRESS: [email protected]

@Bart Ross, Ph.D., Licensed Clinical Psychologist

/
Lightbox image