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Thank you for considering Vivie Therapy as your healing center of choice. The first step for all potential patients is to fill out the New Patient Information Form to verify how much of your treatment will be covered by your insurance benefits.

New Patient Information Form

You can email the completed form back to us at:         and

You may also fax it to us:       (310) 623-4455 Attention: Office

Please also include the following, which are not mandatory but are helpful for expediting the process:

  • A copy of your license or ID with a copy of both sides of your insurance card
  • A copy of your prescription for physical therapy if you have one

We would appreciate it if you follow-up with us by phone after sending your information back to us to make sure we have received your information and can expedite the process.

To save time on your first visit, download the appropriate forms below and complete them as best as possible before you come in for your evaluation.

Patient Health Questionnaire Form

Consent For Care and Treatment Form

Informed Consent Form

Informed Consent (PDF)               Informed Consent (DOC)

Patient Information Acknowledgment & Compliance Forms

Payment Agreement Form
(for Motor Vehicle Accident cases and Out-of-State Insurance Policy holders)

Turbosonic Release Form

We also suggest writing down in as best detail as possible the history of your issue including current goals and concerns because you might forget some details when you are in your session. For car accident patients this is also good for recollection/legal purposes.

If you have hired an attorney that is representing you with treatment, please download the lein agreement form below and have your attorney sign it and bring it with you signed by both you and your attorney.

Lein Agreement Form

We hope this information will make your visit as pleasant an experience as possible. If you have any questions, please contact us.

Looking forward to seeing you here at Vivie Therapy!!!!