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Forms

Intake Forms: All Forms are encrypted and meet the privacy standards for HIPAA

All new patients fill out the 3 electronic forms below and print out the signature form and sign it. The HIPAA document is for your personal files.

INTAKE AND MIND-HEALTH ANALYSIS FORM

https://goo.gl/forms/4cGgyn0cbpziivgL2 

 

LEGAL FORM: TREATMENT FORM AND CARE AGREEMENT: 

https://forms.gle/Z3zonxYuZPBGY4148

 

CREDIT/DEBIT CARD POLICY AND PAYMENT AGREEMENT:

https://forms.gle/T2WpC3aUfUncUdFG6

 

DIRECTIONS TO OUR OFFICE: PLEASE READ getting to our office can be tricky the first time. 

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Intake documents
Session 2 Documents

Brain Nutrition: Using Your Fork to Renovate Your Brain

Sleep Guide: Enhanced Sleep Protocol

Prescription Refill Backup Form

Prescription Refill Backup Form

https://forms.gle/jXnfU7Y8sjF8LX9s8

OFFICIAL OFFICE HIPAA DOCUMENTATION

(please download and keep for your own records):

HIPAA Notice of Privacy Practices

Santa Barbara 
Integrative Psychiatry
 

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The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.

Main Office:
5290 Overpass Road, Suite 128
Santa Barbara, CA, 93111

 

Call: 805-679-3034

Fax: 855-808-4055

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