NOTE: This form is intended for those seeking specific Psychological Assessment/Testing Services. If you are wanting to request an appointment for counseling services with CIFT, please click here to request an appointment with one of our therapists.
NOTE: If you are under the age of 18, please have a parent or guardian complete the form and submit it for you.
Client Name: (required)
Parent, guardian, caregiver name (or N/A if adult); church/pastor (if for a clergy assessment); foster/adoption agency (if for a pre-adoption parent evaluation): (required)
Phone Number: (required)
If appointment is for a minor, please provide parent or guardian phone number.
If appointment is for a minor, please provide parent or guardian email.
Client Age (required):
Client Date of Birth (MM/DD/YY) (required):
We have five different locations in Southern California to serve you. Click on the photos below for more info about any of our offices.