First Visit Patient Forms
Choose the form that best describes you or your child and print single sided. Fill out and bring them to your first visit.

Form AFor pediatric patients > 5 years of age with problems related to attention, learning, behavior, and mental health
 

Form BFor adults and young adult patients > 14 years of age with problems related to attention, learning, behavior, and mental health
 

Form CFor young pediatric patients < 5 Years of Age with autism, developmental concerns, or other health concerns

Form DFor patients ≥ 5 Years of Age with general health concerns

Form E : For adult patients general health concerns 

© 2016 by Lisa Loegering MD. Proudly created with Wix.com

© 2020 by Lisa Loegering MD.

Proudly created with Wix.com

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HOURS OF OPERATION

Tuesday 10:30AM - 6:00PM

Wednesday 10:30AM - 4:30PM

Sat-Sun: Closed

CONTACT

317 14th Street

Del Mar, CA 92014

lisajlmd@gmail.com     

+ 1(858)222-0328     

Fax: 858-275-6351

For Life Threatening 

Emergencies Call 911

LEGAL DISCLAIMER : All advice provided on this website is for informational purposes only and is not intended to be, or serve as a substitute for professional medical or psychological advice, examination, diagnosis or treatment. Always seek the advice of your doctor or other qualified professionals with any questions you may have regarding a medical or psychological condition.