Phone number

I understand Dr. Fox does not accept insurance and is not a Medicare provider. Fees are due in full at the time of service. I understand that appointments are available for patients residing in California, Arizona, and Hawaii.

What is the patient’s full name first and last?

List any current psychiatric medications

Prior psychiatric diagnosis

Have you ever been hospitalized in a psychiatric hospital or required emergency psychiatric treatment?

If you were referred by someone, please state who referred you.