Forms 

Documentation must be completed by a qualified medical professional.
The completed form(s) and documentation need to be faxed to 949-824-3083. 

FormImpairmentUC Guidelines
Verification of Impairment (PDF)
  • Communication
  • Deaf/Hard of Hearing
  • Physical/Medical Disabilities: Permanent or Temporary
  • Visual
N/A
Verfication of Mental Health Evaluation (PDF)
  • Psychological Disabilities
Psychological Disabilities Guidelines
Learning Disability

Psychoeducational Assessment Required
(Check out our Referral Information for Assessments)

  • Learning Disability
  • Acquired Brain Injury
  • Autism/Asperger's
Learning Disabilities Guidelines
Verification of AD/HD (PDF)
  • Attention Deficit/Hyperactivity Disorder (AD/HD)
AD/HD Guidelines