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READ ME FIRST:

Prior to submitting a request for consultation please review Dr. Miller's Private Practice page, including practice style, fee structure, and service offerings. Because Dr. Miller is licensed to practice medicine in California only, patients must be located here or willing to travel here.

Name *

Email *

Phone *

Where are you located? (City and State) *

How did you hear about Dr. Miller? (Referral, google search, etc) *

PLEASE READ THE FOLLOWING CLOSELY AND AGREE PRIOR TO SUBMITTING YOUR REQUEST FOR CONSULTATION:

I am aware that for licensing reasons in order to seek treatment with Dr. Miller I must be either located in California or willing to travel here: *

Yes, I am located in California or willing to travel here
No, I am no located in California or willing to travel here and I will seek out a different psychiatrist

I have reviewed Dr. Miller's fee structure and billing practices at https://zenpsychiatry.com/private-practice/#fees and I understand that Dr. Miller does not accept insurance: *

Yes, I have reviewed Dr. Miller's fee list and I am willing and able to pay those fees
No, I have not reviewed Dr. Miller's fees or am not able or willing to pay them and I will seek out a different psychiatrist

I understand that at this time appointments are done via video only. *

Yes, I am fine with video appointments
No, I prefer in-person appointments and will seek out a different psychiatrist

I understand that Dr. Miller currently has a waiting list and her next available appointment may be 6-8 weeks away. *

Yes, I am able to wait for my appointment
No, I am not able to wait for my appointment and will seek out a different psychiatrist

I have reviewed Dr. Millers Private Practice page and am aware of her practice style and service offerings. I am interested in: *

Essential Psychiatric Evaluation & Treatment
Integrative/Functional Psychiatric Evaluation & Treatment
Not sure

What problem are you dealing with that's led you to to reach out for help? *

What are you hoping to get out of treatment? *

Are there additional questions you need answered to decide if Dr. Miller is the right fit for you? *

Thank you and I look forward to being in touch soon!

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