Forms - Orange Psychiatric Medical Group, Inc., Southern California

Going to the Psychiatrist, Psychologist, Therapist, Marriage or family counsler, licensed clinical social worker can be an overwhelming experience, especially first-time visits. Let us put your concerns and anxieties to rest. Our goal is to make the patient experience comfortable.

Our goal is to provide every patient with

A clean, inviting environment
A warm, friendly greeting when you call or come in
Quality, affordable care for you and your family
Doctors and staff who treat you with respect
Our sincere appreciation for choosing and recommending this office
A clear explanation of every aspect of your visit

Our Psychiatrist, Psychologist, Therapist, Marriage or family counsler, licensed clinical social worker will perform a complete examination and discuss any treatment you may need. Patients under the age of 18 must be accompanied by a parent.

To make your visit as pleasant and brief as possible, there are a few things you should bring with you. With just a few simple forms, we’ll ask for relevant medical history, any medications you might be taking, your family history, and any health insurance coverage you may have.

You're coming to a office because you want to see a Psychiatrist, Psychologist, Therapist, Marriage or family counsler, licensed clinical social worker not be handed a clipboard. Make it easy and download all our patient information forms now. Simply complete the forms and bring them to your first visit.

Patient Packet

Release Authorization

Credit Card Authorization

Telehealth form

Minor Consent

At present Dr. Chundu patients can message him using OnPatient app.

OnPatient Portal

STEP 1
Ask your provider to send you an email invite to the OnPatient Portal

STEP 2
Open the OnPatient invite email, press the “sign up” button and register your account.

STEP 3
Download the Onpatient App from the Apple App Store

Or Google Play “Personal Health Record PHR”

or OnPatient website

STEP 4
Launch the OnPatient app and log in

To complete your “PATIENT PACKET” online Click on “Check in” this will prompt you to the questionnaire you'll need to answer and consent forms you'll need to sign.

NEW PATIENTS: To complete your “ NEW PATIENT PACKET” online

Click on “Check in” on your scheduled appointment. This will prompt the questionnaire that needs to be filled out and consent forms that require your signature. This step is mandatory for all new patients, you may check-in