Forms - Southern California


When you are ready to take your first step on the road to recovery, please complete the appropriate questionnaire form below and submit online to our secure server. If visiting via mobile phone or tablet, please choose the online form. The forms are also available for download in PDF and can be submitted to Klarity Clinic of Southern California via FAX at (888) 945-4264

Your medical records assist us in tailoring your treatment to your specific conditions and circumstances. In order to release your medical records to Klarity, please complete and print the Authorization to Release Medical Records form below and forward to your managing professional.


Depression & Anxiety

Drug & Alcohol Addiction

Chronic Pain Patient Questionnaire

NAD+/IV Nutrient Therapy Questionnaire

Medical Records & Release

Our Locations

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