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Progressive & Holistic Psychiatry

Accepting New Patients. Call Us Now : 805-679-3034

Santa Barbara

Integrative Psychiatry

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.

Session 2 Documents

Brain Nutrition: Using Your Fork to Renovate Your Brain

Sleep Guide: Enhanced Sleep Protocol

Prescription Refill Backup Form

INTAKE AND MIND-HEALTH ANALYSIS FORM

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

LEGAL FORM: TREATMENT FORM AND CARE AGREEMENT:

https://forms.gle/j3x1zXKBvWmH5izW6

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.

Prescription Refill Backup Form

https://forms.gle/jXnfU7Y8sjF8LX9s8

Intake documents

INTAKE SIGNATURE FORM

(please click on the link below and download it to your computer to print out and sign. You may fax this document to: 855-808-4055 or bring with you to your next appointment):

Intake Legal Signature Document

OFFICIAL OFFICE HIPAA DOCUMENTATION

(please download and keep for your own records):

HIPAA Notice of Privacy Practices

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