Carmel-By-The-Sea
If you are a new Psychiatry or Psychotherapy patient, please complete, sign, and e-mail back to Dr. Ambardar the following forms before your first online visit. If you are a new Coaching client, Dr. Ambardar will e-mail you a separate set of intake forms.
(1) New Patient Evaluation Form
(2) Please read our HIPAA Notice and sign the Acknowledgement Of Receipt form.
(3) Office Policies: Please read and sign, paying particular attention to the first page regarding Monthly Medication Management Appointments, Late Cancellations, and No Shows.
(4) Treatment Consent Form: Please read and sign, paying particular attention to the OTHER PROFESSIONAL SERVICES section as excerpted here:
Professional services such as completing prior authorizations for medications, ordering medications outside of regularly scheduled appointments, filling out forms, telephone calls, extensive e-mail conversations, preparation of treatment summaries, or time spent performing any other functions that you may request will be charged $150 for each 15 minute increment.
(5) Credit Card Authorization Form: Please read and sign.
(6) Telepsychiatry & Teletherapy Consent Form: Please read and sign.
Please read about our Medication Refill Policy below before requesting a Psychiatry appointment. Thank you!
