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Westwood, Los Angeles

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New Patients

New Patients

Interested in connecting with us?

Please complete and submit the New Patient Inquiry Form below. Within three (3) business days, you will receive a response via e-mail regarding next steps.

New Patient Form

First Name*:

Last Name*:

Date of Birth*:

Name of person completing this form*:

Relationship to prospective patient*:

Email*:

Phone*:

School and grade (occupation, if adult)*:

Who referred you to us?*:

Reason for seeking care*:

Current symptoms - Select all that apply

Depression

Anxiety

Attention and concentration difficulties

Mania or bipolar disorder

Hallucinations or psychosis

Substance use

Oppositional behavior

Violence or destruction of property

Suicidality

Homicidality

Self-injury

Trauma

Eating disorder

Difficulties with social interactions

Relationship problems

Intellectual disability

Learning disabilities

Tics

Autism

Other

Have you (or your child) ever been hospitalized for psychiatric reasons? If so, when?*:

Have you (or your child) ever tried psychiatric medications?*:

What do you hope we can provide for you?*: (select all that apply)

Medication management

Psychotherapy

Second opinion consultation

Other

Thank you for contacting us.
We will get back to you as soon as possible.

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Home
What is TMS?
Why TMS?
The TMS Process
Self-Assessment for Depression
Westwood Psychiatry
Contact Us

Home
What is TMS?
Why TMS?
The TMS Process
Self-Assessment for Depression
Westwood Psychiatry
Contact Us

Location

Westwood Minds

10921 Wilshire Blvd Suite 409B

Los Angeles, CA 90024

Serving Beverly Hills, Culver City, Los Angeles, Marina Del Rey, Playa Del Rey, Santa Monica, West Hollywood and the surrounding area.

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All Rights Reserved | Westwood Minds | Los Angeles, CA

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