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
- .