Appointment Request - Beverly Hills Concierge Psychiatry

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Please fill out the information below to request an appointment at Beverly Hills Concierge Psychiatry. Our Client Care Coordinator will reach out to you within 48 hours of receiving your completed request.

Name *

First and last name

Age of Patient: *

Email *

Phone number *

How were you referred to La Jolla Concierge Psychiatry? *

I acknowledge: *

La Jolla Concierge Psychiatrists are out-of-network providers and can provide a superbill for the client to submit to insurance for out of network reimbursement

Select the office location where you are requesting an appointment: *

La Jolla, CA (San Diego)

Beverly Hills, CA

Which service are you requesting an appointment for? *

Psychiatry consultation for medication management alone

Psychiatry consultation for medication management and therapy

Psychiatry consultation for therapy alone (not interested in medication at this time)

Briefly describe your reason for seeking a mental health evaluation: *

Are you seeking a physician that offers in-office visits, virtual visits (via Zoom), or a mixture of both? *

In-office only

Virtual only

A combination of in-office and virtual

I am located in the state of California *

Yes

Other:

Have you previously seen a psychiatrist or therapist? *

Yes

Other:

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