INFORMED CONSENT FOR OUTPATIENT PSYCHIATRIC TREATMENT

Dr. Emily Wood, MD, PhD

Medical License A144603

Clinic:	Emily Wood, MD, PhD
Phone:	310-400-6685
Fax:	844-269-5439
Website:	www.emilywoodmdphd.com
Email:	info@emilywoodmdphd.sprucecare.com

Effective Date: June 1, 2026

I. About This Document

This document describes the clinical terms of your psychiatric care with Dr. Wood. Read it together with the Shared Practice Policies & Patient Information document, which governs practice-wide policies including confidentiality, cancellation, billing, communication, and termination. Where this document addresses a topic, it takes precedence over the shared document for your psychiatric care.

This consent applies to adults (18 and older) and to parents or legal guardians consenting on behalf of minors. Where this document refers to "you," it refers to the patient or the parent/guardian acting on the patient's behalf, as applicable. Your signature indicates that you have read, understood, and agreed to its contents. You may ask questions before or after signing.

II. About My Practice

I am a licensed physician in California (License #A144603) and a board certified general, child, & adolescent psychiatrist. I completed my medical training at the Johns Hopkins University School of Medicine and my psychiatry residency and fellowship training at the UCLA Semel Institute.

My practice operates within Emily Wood, MD, PhD, a multidisciplinary practice. Providers and administrative staff within the practice who are involved in your care or billing may have access to your records. A Business Associate Agreement (BAA) governing the use and protection of your health information is in place.

III. Services Provided

Scope of Practice

Dr. Wood is a board-certified psychiatrist specializing in neurodevelopmental disorders across the lifespan, including ADHD, autism spectrum disorder, and related conditions. The following services are provided by this practice:

Psychiatric Diagnostic Evaluation. A comprehensive evaluation of psychiatric, developmental, and family history, mental status, and clinical presentation, resulting in diagnoses and initial treatment recommendations.
Psychopharmacological Medication Management. Review of current medications, discussion of risks, benefits, and alternatives, prescription and adjustment of psychiatric medications, and laboratory monitoring as indicated.
Second-Opinion Consultation. Consultation regarding how psychiatric conditions or treatments may affect a patient's clinical situation, prognosis, or care by other providers. No prescriptions or ongoing treatment documentation are provided in a consultation context.
Case Management. Coordination of care with other providers, educational settings, and community agencies; preparation of letters, forms, and clinical documentation; prior authorization management and pharmacy communication; and related non-visit clinical support.

This practice does not provide ongoing psychotherapy as a primary service. If psychotherapy is clinically indicated, referrals will be provided.

Appointment Types and Session Lengths

Appointments vary in length and purpose depending on clinical need. Dr. Wood determines the appropriate appointment type based on clinical complexity, time since last appointment, medication status, and other relevant factors. Appointment types, current fees, and anticipated annual cost ranges are set forth in the Psychiatry Fee Schedule & Good Faith Estimate, provided as a separate document.

Administrative Time

Time outside of scheduled appointments required for clinical coordination — including prescription management, prior authorizations, pharmacy communication, letters, and forms — is billed per 5-minute increment. The first 5 minutes are not charged for matters directly related to a recent appointment. The current rate is set forth in the Psychiatry Fee Schedule & Good Faith Estimate.

Extended Evaluation Period

Psychiatric diagnosis — particularly for neurodevelopmental conditions — often cannot be completed in a single appointment. Following the initial intake, an extended evaluation period of two to four additional sessions may be required before a final diagnosis and treatment plan are established. This is standard clinical practice. During this period, diagnostic impressions will be shared as they develop, and medication decisions may be deferred pending clarification of the clinical picture.

IV. Voluntary Participation and Right to Withdraw

Your participation in psychiatric treatment is entirely voluntary. You have the right to withdraw consent and discontinue treatment at any time, for any reason, without penalty.

If you decide to stop treatment, please notify the practice so that appropriate transition planning can occur, including referrals and continuity of prescriptions during a medically appropriate transition window. Stopping psychiatric medications abruptly without clinical guidance carries risks; see Section 5.3 below.

Ongoing prescribing requires an active treatment relationship. Dr. Wood will not continue to prescribe medications in the absence of regular appointments.

V. Diagnosis and Treatment Planning

Psychiatric diagnosis is a clinical judgment based on a comprehensive evaluation, including history, mental status examination, and collateral information when available. Diagnoses may evolve as clinical understanding develops over time.

Treatment planning is a collaborative process. Dr. Wood will explain her diagnostic impressions, treatment recommendations, and the reasoning behind them. You are encouraged to ask questions and share your priorities and concerns. No specific clinical outcome can be guaranteed. Responses to treatment vary across individuals, and the goal is to work toward the best possible outcome given your circumstances.

VI. Medication Consent

Before a Medication Is Prescribed or Changed

Before a medication is prescribed or changed, Dr. Wood will discuss the following with you:

The target symptoms or conditions the medication is intended to address
Expected benefits and the anticipated time course of effect
Common and significant potential risks and side effects
Relevant alternatives, including non-pharmacological approaches
Consequences of not treating
Any monitoring requirements (laboratory tests, vital signs, etc.)

You have the right to accept, decline, or request more time to consider any medication recommendation. Consent to a specific medication does not constitute consent to all medications. Consent is ongoing — you may change your mind at any time.

Controlled Substances

Some medications prescribed in this practice — including stimulants — are classified as controlled substances under federal and California law. Prescribing controlled substances requires heightened monitoring, more frequent appointments, and adherence to state and federal regulations. Specific requirements will be discussed if a controlled substance is prescribed.

Medication Discontinuation

Do not stop psychiatric medications abruptly without first consulting Dr. Wood or another prescriber. Many medications require a gradual taper to avoid withdrawal effects or rebound of the underlying condition. If you wish to stop or reduce a medication, contact the practice to discuss how to do so safely. This applies even if you are discontinuing care with this practice.

VII. Appointment Frequency and Prescribing Requirements

To prescribe and manage ongoing psychiatric medications, Dr. Wood requires that all patients be seen at a minimum of every three months. More frequent appointments are required when:

Medications are currently being changed or titrated, particularly during the first three months of treatment or following a significant clinical event
A prescribed medication warrants closer monitoring due to high-risk side effects (e.g., clozapine, benzodiazepines)
Significant changes in life circumstances may be affecting mental health
Other medical issues have arisen that are relevant to psychiatric treatment

For patients prescribed controlled substances, California law and standard clinical practice require more frequent appointments; specific requirements will be discussed.

Ongoing prescribing requires an active treatment relationship. Prescriptions will not be issued or refilled in the absence of regular appointments. If you are unable to maintain the required appointment frequency, Dr. Wood will discuss your options, which may include referral to another prescriber.

VIII. Risks and Benefits of Treatment

Potential Benefits

Psychiatric treatment has the potential to reduce distress, improve functioning, and enhance quality of life. Benefits vary depending on the individual, the condition being treated, and the treatments used.

Potential Risks

General categories of risk include medication side effects — ranging from mild and transient to more serious and requiring intervention — inadequate response to treatment requiring modification of the plan, and in rare cases, worsening of symptoms during or after a treatment change. Specific risks are discussed during the consent process for each medication or intervention.

Risks of Forgoing Treatment

Declining or discontinuing treatment carries its own risks, which may include worsening of untreated symptoms, functional decline, and adverse consequences related to the underlying condition.

IX. Minor Patients

Confidentiality and Parental Access

When the patient is a minor, the parent or legal guardian typically holds legal rights to information about their child's treatment. However, a degree of privacy supports the therapeutic relationship with minors. Dr. Wood will work collaboratively with parents and guardians to share information about treatment progress, goals, and safety — while preserving appropriate privacy for the minor. The specific confidentiality parameters will be discussed with both the minor patient and their family at the outset of treatment.

California law provides additional confidentiality protections for minors in specified circumstances, as described in the Shared Practice Policies & Patient Information document.

Minor Assent

Dr. Wood believes it is important to include minor patients in decisions about their own care in a developmentally appropriate way. The minor's assent — their agreement to participate in evaluation and treatment — is sought as a meaningful part of the clinical relationship, not merely a formality. A minor who has questions or concerns about their care is encouraged to raise them directly.

X. Nature of the Professional Relationship

The relationship between patient and psychiatrist is professional, not personal. Dr. Wood is unable to accept social media connections, provide personal contact information outside the practice, or engage in social or business relationships with current or former patients. These boundaries exist to protect your interests and the integrity of your care. If you encounter Dr. Wood in a public setting, she will follow your lead to protect your privacy.

XI. Legal Proceedings

Treating Clinician vs. Expert Witness

Dr. Wood's role in this practice is as your treating clinician, not as an impartial evaluator. These roles are mutually exclusive. If subpoenaed to testify about your treatment, Dr. Wood may serve as a fact witness — describing what she observed and what treatment she provided — but cannot serve as an impartial expert witness in the same matter.

Independent Forensic Evaluations

If you need an independent evaluation for legal, disability, custody, or other purposes, this practice cannot provide it. A referral to a forensic evaluator will be offered.

Expert Consultation Rate

If Dr. Wood's involvement in a legal matter is required — including subpoena response, record review, deposition, court appearance, or preparation of legal documentation — time outside standard clinical appointments is billed at the expert consultation rate set forth in the Psychiatry Fee Schedule & Good Faith Estimate, regardless of which party requests the involvement. This fee is not reimbursable by insurance.

XII. Medication Continuity During Absences

This practice does not arrange clinical coverage during provider absences, as described in the Shared Practice Policies & Patient Information document. For established patients on ongoing psychiatric medications, Dr. Wood will make reasonable efforts to ensure continuity of essential prescriptions during planned absences. If you are on a controlled substance or a medication requiring close monitoring, please notify the practice in advance if upcoming absences or travel may affect prescription timing.

XIII. Confidentiality

Your psychiatric records are protected by HIPAA, the California Confidentiality of Medical Information Act (Civil Code §56 et seq.), and Welfare and Institutions Code §5328, which provides heightened protection for mental health records. Exceptions to confidentiality are described in the Shared Practice Policies & Patient Information document and apply fully to your psychiatric care.

XIV. Your Rights as a Patient

Your rights — including the right to access records, participate in treatment decisions, refuse or withdraw consent, and file complaints — are described in the Shared Practice Policies & Patient Information document. For concerns specific to your psychiatric care or Dr. Wood's conduct, you may contact:

California Medical Board
2005 Evergreen Street, Suite 1200, Sacramento, CA 95815
(800) 633-2322 | www.mbc.ca.gov

XV. Consent and Assent for Minor Clients

When the client is a minor, a parent or legal guardian must provide written consent for services. If parents are separated or divorced, I may require documentation of the custodial arrangement before initiating services.

I believe it is important to include minor clients in decisions about their own care in a developmentally appropriate way. I will seek the minor's assent — their agreement to participate — as an integral part of our work together.

XVI. Changes to this Notice

We reserve the right to revise or change provisions on this Notice. We will implement the new Notice provisions effective for all services provided and confidential information we maintain. The most current version of this notice will be available on our website at https://www.emilywoodmdphd.com/policies. The Notice will contain the effective date on the top of the first page.

XVII. Acknowledgment and Signature

By signing below, I acknowledge that:

I have read and understood this Informed Consent for Outpatient Psychiatric Treatment.
I have read and understood the Shared Practice Policies & Patient Information document.
I have had the opportunity to ask questions and have received satisfactory answers.
I consent to the psychiatric evaluation and treatment described in this document.
I understand that this consent is voluntary and that I may withdraw it at any time.
I understand the limitations of confidentiality and the circumstances under which information may be disclosed without my authorization.
I have received a copy of the Notice of Privacy Practices.
I understand that signing this document does not guarantee a specific treatment outcome.

Patient (or Legal Guardian if patient is a minor)

Signature: ___________________________________________

Date: ___________________________________________

Printed Name: ___________________________________________

Relationship (if signing on patient's behalf): ___________________________________________