Intake Packet

Thank you for choosing Lorien Psychiatry.

Before your first appointment, we'd like you to fill out some forms. This will probably take between half an hour and an hour. They'll be:

0. Welcome Page (1 minute)
1. New Patient Suitability Form (5 minutes)
2. Contact Information Form (5 minutes)
3. Emergency Situations Form (5 minutes)
4. Intake Form (30 minutes)

Before we start, please give us your name and email. We might use email to discuss confidential aspects of your care, so please make sure to give us a completely secure email address that no one else has access to. 

0. Welcome Page (1 minute)
1. New Patient Suitability Form (5 minutes)
2. Contact Information Form (5 minutes)
3. Emergency Situations Form (5 minutes)
4. Intake Form (30 minutes)

This is the same as the New Patient Suitability page on the website; if you've already read that one, sorry for the repetition. Otherwise, please go through this and make sure you are a suitable patient for this practice.

We try to help a wide variety of people - but because of legal restrictions, our business model, and limitations on my own expertise, we are not suitable for everyone. Appropriate patients will:

0. Be a former patient, or have a referral. Right now I am only seeing my former patients from PCPA, patients referred by existing patients, or patients referred by a therapist I have a working relationship with. 

1. Be age 18 or older. I'm not licensed as a child psychiatrist and I don't see children.

2. Be a resident of the State of California. I'm not licensed to see people from other states. If you're in some sort of complicated college-related or digital-nomad-type situation, I'll see you if you have a residence in California and consider it your "home base", but expect to encounter various problems. In particular, I may not be able to prescribe you medication (especially controlled medication) in other states.

3. Be able to use telepsychiatry. You'll need to have a good Internet connection, be able to reliably use video conferencing, and be willing to put some effort into the appointment - please don't try to see me through your cell phone while you're driving your car or jogging. Although I'll try to have the appointment by phone if there is an unexpected snafu in the videoconference, this should be a last resort and you should generally try to make videoconferences work.

4. Be a suitable patient for telepsychiatry. I prefer not to see extremely high-risk patients through telepsychiatry. If you're frequently psychotic or acutely suicidal, I would prefer you attend in-person visits with a psychiatrist in your area who has close relationships with local psychiatric hospitals and care networks.

5. Understand that telepsychiatry may involve some extra steps. The state of California has traditionally required that patients get seen by an in-person doctor before receiving controlled substances. That means that if I (as your telepsychiatrist) want to prescribe you a controlled substance like Adderall or Klonopin, I can't do this until you get examined by an in-person doctor (probably your primary care doctor if you have one) and have them sign a form saying you seem healthy enough to take the medication safely. This surprises and angers a lot of patients who chose telepsychiatry hoping to avoid the difficulty and expense of seeing an in-person doctor, so be prepared for it. As of my writing this, the government has waived this requirement because of the COVID-19 emergency, but it could come back into force at any time.

6. Have no personal connection to me. Iif you're my family member, friend, or otherwise socially connected to me, it would be a conflict of interest for me to be your psychiatrist. If you've read things I've written online, that doesn't in itself necessarily disqualify you, but keep in mind I won't be interested in talking about these during sessions and will want to focus exclusively on your mental health. If you're involved in the same organizations or communities I am, this might be a conflict of interest - please email me with your specific situation before signing up.

7. Have no strong personal connection to an existing patient. If you were referred to me by a family member or close friend who sees me, this presents a potential conflict of interest. I prefer not to see two people in a relationship that could potentially turn adversarial (eg husband-wife, employee-boss, etc) if there's any chance I might be asked to help either party navigate it. If you were referred by a friend of a friend or something, that's probably fine. If you have any questions about this, please email me with your specific situation before signing up.

8. Understand that this is not a therapy practice. Most of my training is in biological psychiatry, not therapy. Biological psychiatry doesn't always mean medication - it could also mean dietary advice, circadian rhythm hacking, or environmental changes - but medication is often involved. If you would prefer care that focuses on talking about relationships, emotions, and your direction in life, you probably won't find Lorien Psychiatry too helpful - especially since the twenty minute appointments we offer aren't long enough to discuss those things in depth anyway. This doesn't mean I don't care about what's going on in your life or that we won't talk about it. It just means it won't always be the focus of treatment, and that I may not be able to offer deep insights about it that will produce lasting change on their own. Many people get treatment with a biological psychiatrist and a psychotherapist simultaneously, this often works well, and I would be happy to be the biological psychiatry half of this kind of team. I'll try to eventually have some resources up that will help you find the right therapist.

9. Understand that this is not a neuropsychological testing practice. Neuropsychologists diagnose people scientifically and officially, after spending many hours testing them. Their diagnoses can be used for legal issues like criminal cases, suitability-for-work evaluations, and educational accomodations. I diagnose people well enough to treat them, but that's it. Please don't come to me for help getting an official diagnosis of something (or an official diagnosis of not having something) to use in legal proceedings. If in the course of normal treatment you need me to officially sign my name to things like disability documentation, that's fine, but this practice is not for people who primarily need a legal certification service.

By signing your name below, you acknowledge that you have read and understand these issues, and that if I later learn you fall into one of these categories, we may have to discontinue treatment.

0. Welcome Page (1 minute)
1. New Patient Suitability Form (5 minutes)
2. Contact Information Form (5 minutes)
3. Emergency Situations Form (5 minutes)
4. Intake Form (30 minutes)

Everything you tell me is completely private. Only myself and other Lorien Psychiatry staff will have access to it. I can't share it with anyone you know, any other health care provider, or any government agency, with the following exceptions required under law:

1. A subpoena from a court
2. A "duty to warn", where a specific person will be at extreme risk of harm unless I warn them and alert the police
3. Explicit permission from you saying I can talk to a specific person

This last one is important. Without it, I can't talk fully to other people who might be interested your situation (eg your partner calls and says you've been feeling worse lately and wants to know what to do). I also can't communicate with other people who might be involved in your care, like your primary care doctor or therapist.

Below, please list anybody who I have permission to talk freely about your case with. You may want to include a partner, trusted family members, therapists, or other doctors. Please list their names, phone numbers, and (if appropriate) emails. I won't talk to these people unless they initiate conversation or there's a specific reason to talk about your case with them, and I won't mention anything you specifically tell me not to.

If you decide to add or remove people as potential confidentiality exceptions, you can submit a Change Of Information form later. You might need to do this if eg you want me to send your records to a new doctor, or to an agency processing your disability paperwork.

Please consider giving me an emergency contact. The most likely scenario where I'll use this is if I have special reason to be concerned about you and you've stopped answering any of my messages. By listing their name here, you are giving me permission to break confidentiality enough to explain the emergency and try to work with them on solving it. Please don't feel obligated to put anyone's name if you don't want to.

By signing below, you agree that I have your permission to share information about your case with the people you named above.

0. Welcome Page (1 minute)
1. New Patient Suitability Form (5 minutes)
2. Contact Information Form (5 minutes)
3. Emergency Situations Form (5 minutes)
4. Intake Form (30 minutes)

This form deals with some very complicated situations that might come up in extreme cases. Please don't let these scare you - the majority of patients will never run into any of these situations. I'm mentioning them for the sake of full disclosure and preparedness only. These are rules that all psychiatric practices are legally mandated to follow, and the fact that I'm explicitly telling you about them does not mean I will be more likely to apply them than anyone else.

If a psychiatrist learns that you're about to seriously harm yourself, for example by attempting suicide, they're legally required to take action to prevent that - probably calling the police to bring you to a psychiatric hospital.

I take the doctor-patient relationship very seriously and am not a fan of involuntarily committing my patients. In my entire career, I have involuntarily committed one patient for suicidality. I'm not going to commit you just because you are cutting yourself. I'm not going to commit you just because you tell me you sometimes have thoughts about suicide. I'm not going to commit you just because those thoughts are sometimes detailed and disturbing.

If you tell me you have suicidal thoughts, we'll talk about them. If I become concerned, I'll ask you about whether there's a substantial risk you'll try to act on them before our next appointment. If the answer is yes, I'll ask you about whether you think you can call 9-1-1 and/or get yourself to the hospital voluntarily before you act on them. If the answer is no, then I'll involuntarily commit you. I'll follow this algorithm very closely, so nothing that happens should come as a surprise to you. I understand that many depressed people are nervous about seeing psychiatrists because they're afraid of involuntary commitment, but I think we can work together on this and remove any uncertainty.

If a psychiatrist learns that you're about to physically harm someone else, they're legally required to take action to prevent that - probably informing the police and the intended victim, and possibly including calling the police to bring you to a psychiatric hospital.

Again, I take the doctor-patient relationship very seriously, and in my entire career, I've only had to do this once. I'm not going to commit you just because you have fantasies about hurting people you don't like. I'm not going to commit you even if those fantasies are detailed and disturbing.

If you tell me you think about injuring or killing someone, we'll talk about it. If I become concerned, I'll ask you about whether there's a substantial risk you'll act on those thoughts before our next appointment. If the answer is yes, and we can't come up with some plan that makes us both satisfied it won't happen, I may take either or both of the actions mentioned above. This is a very complicated situation and I can't promise to follow an algorithm, but I promise that I will not commit you frivolously.

If a psychiatrist learns that you're so psychotic that you can't take care of yourself, they're legally required to take action to help you - probably calling the police to bring you to a psychiatric hospital.

I've never had to do this in my career so far. But some situations where it might come up are: if you express belief that you can survive deadly things, like jumping off cliffs or running into traffic, and you seem likely to try. Or if you completely stop eating and drinking because you don't think you need sustenance, or are too confused to want it.

If you tell me things like this, we'll talk about them. If I become concerned, I'll ask you about whether there's a substantial risk these issues will harm you before our next appointment. If the answer is yes, and we can't come up with some plan that makes us both satisfied it won't happen, I will involuntarily commit you. I may also commit you if you're so unwell that you can't answer my questions coherently and I can't assess you. This is legally and ethically complicated, but again, I'll try to err on the side of not committing you frivolously.

A "psychiatric living will" is a decision a patient makes, while they are feeling well, about what other people should do for them when they are not in their right mind. You can get very formal with these, but informally, I want to know whether you want me to err on the side of making sure you are safe and healthy (including possible involuntarily commitment) or on the side of respecting your autonomy (and probably not involuntarily committing you). Nothing you say here will prevent me from committing you in situations where I am legally required to do so (the three situations mentioned above), but it might guide my decision-making in any edge cases.

If you're not in your right mind, it might be helpful to delegate decisions around your care to someone close to you who you trust and who shares your values. If you give someone's name and phone number below, then if I ever judge you are not in your right mind, or am otherwise extremely concerned about you, I will call that person and involve them in decisions about you, including whether or not to involuntarily commit you. And if they ever call me with concerns and ask me to act on them, I will take their concerns as seriously as if you were requesting me to act yourself.

By including someone's name and phone number below, you are giving me permission to break confidentiality and inform that person about your condition if I believe the situation is serious enough. If you prefer not to include anyone's name, I will default to my own best judgment and the preference you expressed above. Please don't feel obligated to put anyone's name if you don't want to.

By signing below, you acknowledge that you have filled out this form to the best of your ability and understand that some of your decisions may involve waiving your right to confidentiality in emergency situations.

0. Welcome Page (1 minute)
1. New Patient Suitability Form (5 minutes)
2. Contact Information Form (5 minutes)
3. Emergency Situations Form (5 minutes)
4. Intake Form (30 minutes)

This form gives me basic information about you and your case. Please fill it out even if I already know you from a previous practice, since it will help keep me up to date and make sure the information gets into your new chart.

It's important that you give good, complete answers to these questions. They are important in determining your care. I don't want to take up too much of your time repeating all of these questions back at you one by one in an appointment, but in order to avoid that you need to fill them in carefully now.

If any question is too complicated, just leave it blank and we can talk about it during our first appointment.

If yes, then please go to https://uforu.co/patients and fill in their form.