New Patients

Request an Appointment

Complete the form below and our office will contact you within two business days to confirm your appointment and physician assignment. All initial evaluations are conducted via secure video and last 60 to 90 minutes.

Prefer to call? Reach us at (650) 248-2467 Monday through Friday, 9 AM to 5 PM Pacific.

Your Information

First Name *

Last Name *

Date of Birth *

Are you located in California? *

Yes

No

Phone *

Email *

Preferred Contact Method *

Phone Call

Text Message

Email

Insurance

Insurance Plan *

Not sure if we accept your plan? View our insurance page or select your plan and we will confirm eligibility when we call.

Appointment Details

Physician Preference optional

No Preference

Dr. Lodhi

Dr. Patel

Dr. Staley

If you have no preference, we will match you with the physician best suited to your clinical needs.

Reason for Visit *

Have you seen a psychiatrist before? *

Yes, currently

Yes, in the past

No, this is my first time

Are you currently taking a benzodiazepine? *

Examples: Xanax (alprazolam), Ativan (lorazepam), Valium (diazepam), Klonopin (clonazepam)

Yes

No

Please be aware that our practice does not prescribe benzodiazepines. If you are currently taking one prescribed by another physician, we are happy to discuss your care but will not continue this class of medication.

How did you hear about us? optional

Before You Submit

ADHD evaluations: If you are seeking an evaluation for ADHD, please be aware that a complete diagnostic evaluation typically requires two to three sessions. Medication will not be prescribed prior to the completion of the evaluation.

Intake paperwork: Once your appointment is scheduled, you will receive intake forms through the patient portal. This paperwork must be completed at least 24 hours before your appointment or your appointment will be rescheduled.

This form is transmitted securely. No protected health information is stored in the browser.

By submitting, you acknowledge that you are 18 years or older, are currently located in California or willing to be in California for appointments, and understand that this is a request, not a confirmed appointment.

What happens next?

Our office will review your request and contact you within two business days. We will confirm your insurance eligibility, match you with the appropriate physician, and send you a secure link to complete your intake forms before your first visit.

Need to talk to someone?

If you have questions about whether we are the right fit, our office is happy to help.

(650) 248-2467

If you are experiencing a psychiatric emergency, please call 911 or go to your nearest emergency room. You may also contact the 988 Suicide and Crisis Lifeline by calling or texting 988. This form is not monitored for emergencies.