Book Appointment — Introspection Beverly Hills

3 EASY STEPS TO SCHEDULE AN APPOINTMENT

Zero Paperwork. Let’s Get Started!

Step 1. Register

Please complete the form below. Have your insurance info, and preferred pharmacy details on hand for a seamless process.

Step 2. Policies

Please review our group’s Policies, electronically signing the document as requested.

Step 3. Book Appointment

After we have received your registration information and signed policies, we will contact you to schedule an appointment. Any Questions? Call us at 424-421-4514 or write us at scheduling@introspectionbeverlyhills.com.

Client Information Form

Name*
First Name Last Name
Email*
Phone*
Why are you interested in making an appointment?*
Perhaps you have never seen a mental health professional and you are feeling stressed, anxious, struggling to get a good night of sleep. Or perhaps you recently moved to LA and are looking to establish care with a new mental health professional. Whatever the reasons may be - please let us know. And don't be concerned about writing too much - the more info - the better. It's important to note that if you are making the appointment to secure paperwork - NO PAPERWORK WILL BE COMPLETED DURING THE FIRST TWO VISITS. People likely to benefit from their experience with our group are typically interested in establishing an ongoing relationship focused on improving their overall health and happiness. If you are primarily interested in disability paperwork or a service animal letter our group is not an appropriate match.
Our group uses Zoom (this is similar to Facetime and Skype) which enables clients to meet with their clinicians virtually using secure video-chat from your computer or phone. You can meet with your doc from the comfort of your own home or office. Clients love it and so do our doctors. Do you have a smart phone or computer, so you can meet with your clinician via Zoom?*
In order to use Zoom to meet with your clinician virtually, you will need a computer or smartphone and a reliable internet connection. Our client support team will also do a test video-chat with you to confirm your equipment and internet connection work, prior to scheduling you for a virtual session with a clinician. Additionally if you are a new client and your physician determines that you would benefit from a controlled substance medication prescription, you will have to have an in person visit first.
Are you interested in Couples Counseling?*
Name of Partner for Couples Counseling

If you are interested in Couples Counseling, please enter the name of your partner that will participate in Couples Counseling. In order to schedule you and your partner for Couples Counseling, your partner will have to register as a client, completing registration and signing the payment policy as well.
Address*
Street Address City State ZIP Code
Social Security Number*
Date of Birth*
MM slash DD slash YYYY
Height (feet/inches)*
Weight (lbs)*
Gender*
Employment / School Status*
Employer*
Other
Payment - Primary Insurance Information
Identify the healthcare insurance you are using. If you are not using insurance, simply select the option that says I'm not using insurance and am paying myself.
Please select your primary healthcare insurance*
NOTE: Contact your insurer directly by calling member services on the back of your insurance card to confirm what your mental health benefits are and understand what your financial responsibility is. You should ask them to explain your "outpatient mental health benefits" to you. If you have Blue Shield or Blue Cross / Blue Shield please contact your insurer directly and confirm who your mental health benefits are provided by. Our group does not participate as an in network provider with Magellan insurance.
Please enter your insurance ID including all letters*
Please take a photo and upload a copy of the FRONT of your PRIMARY insurance card.*
Max. file size: 128 MB.
Please take a photo and upload a copy of the BACK of your PRIMARY insurance card.*
Max. file size: 128 MB.
Secondary Insurance
Do you have a secondary insurance?*
Secondary Insurance Information
If you have secondary insurance information, please enter that information here.
Please select your healthcare insurance*
Please enter your insurance ID including all letters*
Please take a photo and upload a copy of the FRONT of your SECONDARY insurance card.*
Max. file size: 128 MB.
Please take a photo and upload a copy of the BACK of your SECONDARY insurance card.*
Max. file size: 128 MB.
Your Preferred Pharmacy
All prescriptions are handled electronically. Please indicate the Pharmacy Name, Address and Phone Number, so that we have your pharmacy on file. Only the pharmacies on this list have demonstrated that they can reliably accept all electronic prescriptions.
Select A Pharmacy From This List
Pharmacy Phone Number
Pharmacy Address
Street Address City State ZIP Code
Referral Information
How did you hear about us?*
Were you referred to our group by another Physician?*
Parent / Spouse / Partner - Subscriber Details
If you are covered under someone else's insurance, such as your parent, spouse or partner or you are a parent bringing your child to Introspection Beverly Hills, APPC please provide the information below - it is required. The information below refers to who the subscriber to the insurance plan is, i.e. your parent, spouse or partner, or yourself if you are the parent bringing a minor for an appointment.
Name
First Last
Email
Phone
Date of Birth
MM slash DD slash YYYY
Height
Weight
Gender
Employer
Address
Street Address City State / Province / Region ZIP / Postal Code Country
All information is transacted using 256 bit encryption via a SSL connection.
Once you successfully click Submit, you will be redirected to review and complete our Policies. After we receive your registration information and signed policies we’ll confirm an appointment for you.
We have taken great effort to develop client-focused processes that ensure transparency, efficiency and optimize client satisfaction and outcomes. We hope to exceed your expectations and make all of your appointments, starting with your first one, as convenient, relaxing and stress-free as possible.

3 EASY STEPS TO SCHEDULE AN APPOINTMENT

Zero Paperwork. Let’s Get Started!

Step 1. Register

Step 2. Policies

Step 3. Book Appointment

Client Information Form

Payment - Primary Insurance Information

Secondary Insurance

Secondary Insurance Information

Your Preferred Pharmacy

Referral Information

Parent / Spouse / Partner - Subscriber Details