Book a Psychiatrist Appointment in Los Angeles

Book An Appointment

Appointment Request

Please fill out this form and we will contact you shortly to schedule a time for your appointment.

First and Last name of patient

Mobile phone number

Patient date of birth

Month

Day

Year

Payment Method

Self-pay

Insurance

If insured, please provide your insurance carriers name

Current psychiatric diagnosis. If none yet, what you'd like us to evaluated for?

Current medications

Prior psychiatric hospitalizations: number of times and year of most recent

Substance use (indicate if currently using)

Name of preferred provider at Prescribed Wellness

Reason for seeking care at Prescribed Wellness Psychiatry

How did you hear about us?

Disclaimer: completing this inquiry form does not establish you as a new patient. Our intake coordinator will contact you upon receipt of the completed form. If you are having an emergency please call 911, 988, or head to your nearest ER. We appreciate your interest.

PW

Book An Appointment

Appointment Request

Address

Hours

Patients

Practice