Thank you for allowing me to assist you during your journey. From this website, you can download, complete and return the Intake Packet. In the packet, you will find instructions on how to set up a Doxy.com tele-health call. You can pay for your session if you are not a Kaiser patient. If you are a Kaiser patient, please pay your copay through the Venmo section below.
SCHEDULE A SESSION
Please email us: [email protected] and give us your name, Date of Birth, Phone Number, Email and issues you would like to be seen for. We will email you back within 48 hours.
PLEASE RETURN HERE TO COMPLETE THE PAPERWORK IF YOU ARE A NEW CLIENT OR IF YOU ARE AN EXISTING CLIENT AND YOUR INSURANCE HAS CHANGED PLEASE COMPLETE THE INTAKE PACKET AND MAKE ANY PAYMENTS NECESSARY. THANK YOU.
Before your Live Video Session please check the following.
- If you have an Iphone go to the app store and download the application Doxy.me telemedicine.
- The address to access the video portal is doxy.me/sh
- If you use a PC or Laptop just go to the doxy.me.com website and use doxy.me/sh to join a session with me.
- Please make a test call to make certain you can connect with Doxy prior to the scheduled appointment time. It is your responsibility to check the connection on your end. We will try once to make the connection, if you can't connect you will can be charged a reschedule fee.
Please complete the Intake packet by clicking on the button below. You can type on it and then return it to me. If you can't type on the PDF and need to download the paperwork and complete it manually, please return it to me by scanning it to me as an attachment and email it to: [email protected] or fax it to me at (909) 945-2855.
If you received confirmation that I am an in network provider on your insurance panel, I will be happy to supply you with a SuperBill (a receipt that you can file with your insurance company for reimbursement). Please fill out the SuperBill form in the Intake packet and return it for our signature. We will email it back to you once your session is completed. We will ask you for a debit, credit or health spending card number so we can charge your co-payments if you are a Kaiser patient or charge your session fee.
We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.