Universal Psychiatric Medical Center 3250 Wilshire Boulevard, Suite 930 Los Angeles, CA. 90010 (213) 739-0019 Date: Dear (Dr) _______(Esq.)  Your patient, __________, was seen today for a pain related psychological evaluation. Our initial clinical impression seems to indicate that the patient is experiencing _____________(diagnosis) symptoms and therefore may be appropriate for a traditional psychological evaluation to determine the nature and extent of the apparent symptoms.  (Also,) Please refer your client, _____________, to individual psychotherapy to provide additional support to her/his in order to better manage current symptoms of depression and anxiety related to her/his work injuries.  We will continue to provide her with (biofeedback therapy doctors follow ups medication management) until which time Mr./Ms. ______ is successfully transitioned into another treatment program.  We are closing the patient’s case out immediately as patient is scheduled to be declared P&S. We are recommending immediate Future Psychiatric in the form of psychotherapy to maintain patients safety. Please contact Dr. Thomas Curtis, MD, at the number provided below. Thanks in advance. Referral for psychotherapy: Dr. Curtis’ office locations closest to your client: 110 W. Ocean Blvd #M Long Beach, CA. 90802 (562) 901-0822 1127 Wilshire Blvd #710 Los Angeles, CA. 90017 (213) 482-9434 The office will need faxed a claim form, an application form, a referral letter from the PTP, and a report recommending psychotherapy to (818) 908-5185. If I can be of further assistance please feel free to contact the office at ( ) Sincerely, psychologist - .