And former patients that have not been seen for 3 years or more. 3 years is defined as 35 months and 2 weeks from the last appointment.

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Welcome! Every request is important to us. Please complete the following form to request an appointment and have a discovery call. A staff member will follow up with you as soon as possible to discuss further You need to decide on 4 things:

Choice of Physician
How quickly do you need an appointment?
What type of appointment would you like?
Are you interested in physcians services as a:

Treating Physician, or as a
Consulting Physician

FIRST, Choice of Physician

Do you have a preference for the choice of the Physician?

Dr. Farshid Rahbar, MD

Dr. Dipti Sagar, MD

No preference, either Dr. works

Whomever Physician Can provide an Earlier Appointment

I am not sure, I need to discuss it with the New Patient Coordinator.

Dr. Rahbar

More Info

Dr. Sagar

More Info

SECOND, which appointment type do you want?

What type of appointment are you requesting??

Appointment Type: Physician Prompt - $1695

Details

We take extra effort to accommodate your appointment as quickly as possible, generally within 2-4 weeks.
$200 non-refundable deposit is required to book the Prompt Appointment.

Appointment Type: Physician Standard - $1495

Details

Implies that we provide an appointment based on availability.
$200 non-refundable deposit is required to book the Standard Appointment.

Appointment Type: Telemedicine Consultation - $1595

Details

We provide an appointment based on availability.
$200 non-refundable deposit is required to book the TeleMedicine Appointment.
We offer Telemedicine consultation on a case-by-case basis.
For New Patients, limited to California residents.
For Out of State residents, we may consider a telemedicine, consultation only, if the patient is referred by a Treating Healthcare Practitioner (M.D. or D.O.) licensed in their State. A Letter of Referral and reason for referral is required.
International residents, please discuss with our New Patient Coordinator.
An initial in-person visit is highly recommended.
More Info

Appointment Type: Physician FAST-TRACK- $2500

Details

We take extra effort to accommodate your appointment as quickly as possible, generally within 1 week. Including Saturday accommodation.
$500 non-refundable deposit is required to book this Appointment.

Appointment Type: Physician FAST-TRACK + Concierge & Elite Service - Fee Individually Customized

Details

Eligible for FAST-TRACK initial appointment. -$2500
Ideal for patients that need to have direct access to the physician (encrypted texting)
Like to have a physician as their “Personal Care Coordinator” (PCC)
Eligible for house calls (when there is medical justification and proximity allows)
We take extra effort to accommodate your appointment as quickly as possible, generally within 1 week. Including Saturday accommodation.
$500 non-refundable deposit is required to book the FAST-TRACK Appointment.
Minimum commitment, 6 months
Request a Quote after your appointment.
No obligation until your first visit is completed.
Individually customized. Best to discuss after your visit with the doctor.

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What type of appointment are you requesting?

Please choose after reviewing above

Physician Prompt

Physician Standard

Telemedicine (Video or Phone) Consultation

THIRD, learn more if you like to retain Physicians' Services as Consulting or Treating Physician.

Understanding Treating Physician vs. Consulting Physician

To visit the physician as your Treating Physician, we require enrollment in our Membership Program. As a Treating Physician, the practitioner will provide medical evaluations as well as order diagnostics (lab & imaging), prescribe medications, assist with referrals, and recommend supplements and will be involved in your day-to-day medical supervision. The fee for the membership program is in addition to fees required for medical evaluations, diagnostics, and therapeutics.

Membership Program (12 months) | BEST VALUE $1500
Membership Program (6 months) | $1100
ELITE Concierge Services | Fee Individually Customized. Please discuss with Dr. Rahbar directly, preferably after your visit.

To visit the physician as your Consulting Physician, membership is not required. The practitioner will only conduct a medical evaluation and provide you with recommendations that you may implement through care and supervision of another treating doctor. Patients may request additional follow-up consultations or can request to be enrolled in our Membership Program (Ask for availability)

FOURTH, Granted we have availability; would you like to be enrolled in our Membership Program?

Please select one of the options below*

Yes, I like to be enrolled

Yes, I like to be enrolled, but want to wait until after my first appointment.

No, I like only to consult with the physician

Now, please answer a few more questions

1. Were you referred by a healthcare provider?

Yes

I am a former patient of the practice more than 3 years ago

If yes, please specify the name of the practitioner?

Please tell us how you heard about us?

Google Search or self-search

Word of Mouth

Patient of practice

Yelp Reviews

Other sources -please specify below

Other sources - please specify

2. Your name or nickname*

3. Your Age

4. Your Gender

Female

Male

Other

Prefer not to say

5. Do you plan to use insurance for some of our outside services?

PPO

Medicare

Covered California or other government insurance

6. Have you reviewed the information on our website?*

Yes

We recommend you review our website and Doctor’s credentials before submitting this form.

7. Have you reviewed the Must Read Page on our website and would you agree to review this information prior to your consultation with the physician?*

Yes

We recommend you review our Must Read Page before submitting this form.

Case Complexity Questions

1. How many practitioners have you visited in the last 2 years or so?

2. What did you feel was missing in your care with your previous physician(s)?

3. Approximately when did your illness start?

4. Do you currently take any supplements?

5. Do you currently take any prescribed medications?

6. Have you ever consulted with an alternative medicine practitioner?

7. Do you currently have a treating physician?

Dedication To Recovery

How dedicated are you about understanding your illness and recovering?

Budgeting Your Cost

The estimated cost for physician’s time, holistic model testing, and supplements may range from $5,000 to $10,000 or more over a 6- to 12-month period.

Are you comfortable making this level of financial investment in your health?*

Yes

Not Sure

Questions Regarding Minors and Those with Impaired Decision-Making Capacity

1. Are you making an appointment for another person?

2. Please describe your relationship with the patient

3. If yes to the previous question, is the individual 18 or over?

Important: If the individual is 18 or over, the individual must personally sign the Office Agreements.

4. If the individual is under the age of 18 or is impaired as far as decision-making capacity, do both Parents/Guardians agree on our holistic services?

(The answer must be YES, or we cannot schedule an appointment for you)

Important: If more than one Parent or Legal Guardian is involved, both parties need to sign the Office Agreements.

Important: If two parents are involved but only one individual has full guardianship, we would need a legal/court document affirming the legal guardian.

Questions regarding who pays for the services (the Guarantor)

Please type Yes or No

Who is the Guarantor for services?

Is the patient the guarantor?

Is the parent the guarantor?

Is the legal guardian the guarantor?

Is a Third-Party paying for our services?

Important: If Yes to the previous question, we require a Third-Party Guarantor Agreement to be signed.

LASTLY, Set up a Discovery Call

Option 1: Schedule Online

If you do not see an available spot on the online calendar, please proceed to Option 2.

Option 2: Tell us more how best to reach you

Best days of the week to call you:

Best times of the day:

The discovery call is with a staff member, not the physician. There is no fee for the discovery call. It will help us to mutually understand if our practice is the right fit for both of us. A discovery call is not immediate and requires a designated time.

Email*

Phone*

Reason for your visit or additional comments*

I understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form.

DISCLOSURES:

What to do after your Membership Program Expires

1. Renew your Membership Program to receive the same level of services

2. Pay the Minimum Annual Administrative Fee to receive basic care

DISCLAIMERS:

Please use this form for general information purposes only. DO NOT send personal information through this form. Specific patient care issues must be addressed during your appointment.

Availability will vary depending on your request. Submitting the form is not a guarantee of making an appointment. Please note that our response time may vary depending upon the number the practice inquiries we receive and our resources available to respond. We appreciate your patience.

Never use this form for urgent matters!

Signature*

How Did We Do?

New Patient Appointments

FIRST, Choice of Physician

Dr. Rahbar

Dr. Sagar

SECOND, which appointment type do you want?

Appointment Type: Physician Prompt - $1695

Appointment Type: Physician Standard - $1495

Appointment Type: Telemedicine Consultation - $1595

Appointment Type: Physician FAST-TRACK- $2500

Appointment Type: Physician FAST-TRACK + Concierge & Elite Service - Fee Individually Customized

THIRD, learn more if you like to retain Physicians' Services as Consulting or Treating Physician.

Understanding Treating Physician vs. Consulting Physician

FOURTH, Granted we have availability; would you like to be enrolled in our Membership Program?

Now, please answer a few more questions

Case Complexity Questions

Dedication To Recovery

Budgeting Your Cost

Questions Regarding Minors and Those with Impaired Decision-Making Capacity

Questions regarding who pays for the services (the Guarantor)

LASTLY, Set up a Discovery Call

Option 1: Schedule Online

Option 2: Tell us more how best to reach you

Visit Us

New Patient Appointments

FIRST, Choice of Physician

Dr. Rahbar

Dr. Sagar

SECOND, which appointment type do you want?

Appointment Type: Physician Prompt - $1695

Appointment Type: Physician Standard - $1495

Appointment Type: Telemedicine Consultation - $1595

Appointment Type: Physician FAST-TRACK- $2500

Appointment Type: Physician FAST-TRACK + Concierge & Elite Service - Fee Individually Customized

THIRD, learn more if you like to retain Physicians' Services as Consulting or Treating Physician.

Understanding Treating Physician vs. Consulting Physician

FOURTH, Granted we have availability; would you like to be enrolled in our Membership Program?

Now, please answer a few more questions

Case Complexity Questions

Dedication To Recovery

Budgeting Your Cost

Questions Regarding Minors and Those with Impaired Decision-Making Capacity

Questions regarding who pays for the services (the Guarantor)

LASTLY, Set up a Discovery Call

Option 1: Schedule Online

Option 2: Tell us more how best to reach you

Visit Us

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