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If you are using your IPAD, make sure to download adobe acrobat so that you can edit the form. To submit, go to the bottom right of the page and choose Share File (Share Flattened Copy), then email it to us:

To keep track of your submission and access reports, please access the Ike Pono Hippa Compliant Cloud

Most common codes used for psychologists, social workers, mental health councelors:


90791 - Psychiatric diagnostic evaluation

90832 - Psychotherapy 30(16‐37*)min

90834 - Psychotherapy 45(38‐52*)min

90837 - Psychotherapy 60 (53+*)min

90846 - Family psychotherapy (without the patient present)

90847 - Family/Conjoint Therapy

90853 - Group psychotherapy



90839 - Psychotherapy for crisis, first 60 minutes

+90840 - Add-on for each additional 30 min of crisis therapy


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