Please download, print, and complete ALL forms provided in the link.
If you have any questions on the Patient Intake Form, please call the office at 805-612-5293.
For billing and insurance questions, email Victoria House at
Please remember to bring your completed forms, along with the following pieces of information, to your scheduled appointment:
Referrals (If required by your insurance)
Co-payments (If required by your insurance)
Please use the link provided to download and print the patient forms.
If you are using insurance, please click on the button below and complete the Insurance Form:
If you are paying privately, please click on the button below and complete the Private Pay Form:
Send the Patient Information & Financial Agreement Form
to the billing office at: VHOUSE@HOUSEBILLING.COM
Fax to (866) 849-0672.
*YOUR INFORMATION WILL BE VERIFIED AND CONFIRMED VIA EMAIL*
We require prior verification of eligibility in order to use insurance as the method of payment. If insurance has not been verified, the appointment will be charged out-of-pocket and the fee will be collected at check-in.
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