Our Philosophy

First, let me start by welcoming you to my practice! I hope to share with you some insight into what informs my practice, and some information about myself, in order to help you find someone that will be compatible with what you are searching for.

Unlike many physicians who went straight out of college into medical school, I did not know that I wanted to be a physician until later in life. I spent many years doing everything from business, to backpacking Central and South America, to waitressing, before finding the work that I love and feel so grateful to be able to do. As a result of my varied background, I often bring a different perspective to my practice, both in therapy and medication management, than other mental health professionals.

From the time I have entered medicine, I have always worked to treat every one of my patients as if they were my own family member, spouse, child or friend. Everyone has different struggles to varying degrees in their lifetime, and it is my goal to help my patients through those times and give them the strength and mindset to achieve mind and body wellness. My goal is always for patients to know they have someone who is there for them, and who strives to do what is in your best interests at all times.

Because of my focus on the relationship, and desire to work unencumbered by potential conflicts of interest, I do not receive any funding or work for any pharmaceutical or medical device companies, and left the managed care industry and do not accept insurance at this time. This allows me to not only spend more time getting to know you and your loved ones, and focus just on medication or therapy, but also to collaborate with your other providers, review and contextualize your medical history, personally answer your calls and emails, help refer you to other providers, and spend time on the "whole person" that you are, not just on a checklist of symptoms. This also means that if you are in "crisis" there will always be someone you can reach, and I can modify my schedule to see you sooner. I also offer weekend and evening appointments for flexibility.

To that end, we often will discuss all the factors that may be contributing to your current state of mind and health, including exercise, nutrition, spirituality, relationships, etc. I believe in and am happy to refer to integrative, non-Western medicine (massage, acupuncture, etc.) practitioners as well. I believe strongly that therapy either with or without medication management is extremely effective, and if you already have a therapist, I will work in tandem with them. And if there is a treatment that I am not currently providing (such as ECT, TMS, VNS, Ketamine infusions, Suboxone, Child/Adolescent Psychiatry, Family Therapy, etc) I can refer you to someone I trust.

About Dr. Wakil

Publications

"Exacerbation of psychotic disorder during pregnancy in the context of medication discontinuation," Psychosomatics, Dec 2012, Wakil, L, MD, Perea, E, MD, Penaskovic, K, MD, Steube, A MD, and Meltzer-Brody, S, MD.

"Premenstrual Dysphoric Disorder: How to Alleviate Suffering," Current Psychiatry, April 2011, Wakil, L, MD, Girdler, S, MD, and Meltzer-Brody, S, MD.

"Repetitive Transcranial Magnetic Stimulation (rTMS) for Antenatal Depression," American Psychiatric Association, 2009, Kim, DR, MD, Gonzalez JM, MD, Christancho P, MD, Wakil L, MD, Parry S, MD, Elovitz MA, MD, Rickels K, MD, Thase ME, MD and O'Reardon JP, MD.

"A Case of Delayed Onset of Threatened Premature Labor in Association with Electroconvulsive Therapy in the Third Trimester of Pregnancy," J. ECT, March 2010, Pesiridou A, Baquero G, Christancho P, Wakil L, Altinay M, Kim D, O'Reardon JP.

"Neonatal outcomes with the use of lamotrigine for bipolar disorder in pregnancy and breastfeeding: a case series and review of the literature," Psychopharmacology Bulletin, 2009, Wakil L, Epperson CN, Gonzalez J, O'Reardon JP, Kim D.

"Branched stent-grafts: will these become the new standard?," J. Vascular Interventional Radiology, June 2008, Chuter, TA, Hiramoto JS, Chang C, Wakil L, Schneider DB, Rapp JH, Reilly LM.

"The Systemic Response to Endovascular Repair of Abdominal Aortic Aneurysm," Houston Aortic Symposium, Laura Wakil, MD, Timothy A. Chuter, DM, Benjamin Howell, Darren B. Schneider, MD, Joseph H. Rapp, MD, Linda M. Reilly, MD, and Jade S. Hiramoto, MD.

"Subclinical Embolization after Carotid Artery Stenting (CAS): New Lesions on Diffusion Weighted MRI Increase with Time Post-Procedure," J. Vascular Surgery, May 2007, Joseph H. Rapp, MD, Laura Wakil, Rajiv Sawhney, MD, Xianmang Pan, MD, Midori, A. Yenari, MD, Christine Glastonbury, MD, Sheila M. Coogan, MD and Max Wintermark, MD.

Services & Fees

All services begin with an initial 80-minute evaluation. If you have submitted your medical records or other relevant information prior to your appointment, I will already have reviewed your records. The initial evaluation will involve discussing what brought you or a family member/spouse in for treatment, and an initial treatment plan which may involve medications, therapy, lab work, imaging and/or referrals to other physicians or testing in the community. The initial appointment provides both of us an opportunity to see if my practice and services will be a good fit for your needs.

For follow-up appointments, I provide the following services, which are all 50-minutes in length except for medication management only (25 minutes):

• Individual therapy with or without medication management
• Medication management
• Couples counseling
• Psycho-education appointments
• 2^nd opinion consultations
• Expert witness testimony for legal issues and court appearances, including custody disputes
• Integrative psychiatric treatment including customized supplements plans
• Functional Medicine—testing and evaluation of the root cause of your illness

*Please note that although I am certified and experienced in Buprenorphine prescribing and Transcranial Magnetic Stimulation, I am not offering those services at this time

Insurance

I am not currently contracted with insurance companies. This is due to my desire to provide personalized, concierge-style care that is tailored to and dictated by your individual needs. However, I recognize that paying for services when you have insurance can be difficult for many patients. Many patients do not realize that many insurance plans do provide some out-of-network mental health benefits. Before scheduling your appointment, please contact your insurance carrier and inquire about your benefits and percentage of reimbursement. The office will provide a receipt of services (a "superbill") that you can submit for reimbursement.

*At this time, Kaiser Permanente, Medicare and Medi-Cal will not reimburse

Fees

Full payment is due at the time of service. All new patients are required to have a credit card on file that will only be used to bill for authorized services. I accept payment by cash, check, and credit card. Please note that there is no sliding scale available at this time.

*If an appointment is not kept or canceled less than 24 hours prior, the full charge will be incurred.

• Initial 80-minute evaluation: $485
• Follow-up 50 minute appointments: $300
• Follow-up 25-minute medication management only: $180

Frequently Asked Questions

Why do I need to see a psychiatrist for medication management? Can't I just get a prescription from my primary care doctor or one of my other specialists?

Many people do see their primary care physicians for psychiatric medications. However, psychiatrists specialize in this area and have significantly more training to help accurately diagnose and treat you. For example, I can provide you with information about your myocardial infarction (heart attack) and medications for your heart, but would not feel comfortable prescribing medication for your heart, since I know there are specialists that can do a better job when it comes to the heart! In addition, you may feel you have never had an accurate diagnosis, or perhaps want to know how to effectively decrease your medication, or have a special circumstance, such as medications in pregnancy.

Why see a psychiatrist for therapy? What is the difference between therapists, psychologists, and psychiatrists?

Therapists may either be licensed clinical social workers, have a master's degree in counseling, or may have a master's degree in marital and family therapy. Psychologists have further graduate education and are considered "doctors" (Ph.D. or Psy.D.) but unlike medical doctors cannot prescribe medication. There are many excellent practitioners for therapy, but many clients prefer to have "one practitioner" who handles both their medication and psychotherapy. In fact, this often allows for more nuanced medication adjustments if your psychiatrist is also seeing you for therapy on an ongoing, frequent basis. Many patients are surprised to learn that many psychiatrists have extensive training in psychotherapy, often more years than those practitioners described as "therapists."

Do you believe in giving everyone medication?

Many people do not warrant medications, or for differing reasons, are reluctant to take medications. I believe in working with you to meet your goals, though I may at times make strong recommendations. I also believe in our bodies' endogenous system of healing, though under certain biological or environmental conditions, that system may go awry and need some assistance in the form of medications, therapy or lifestyle changes.

If I take medication, does that necessarily mean I have mental illness which will be recorded on my medical records?

Even if you are seeing a fee-for-service (i.e. not accepting insurance) provider, psychiatrists all document our diagnosis code (ICD-10 code) in our notes (or should) which your insurance company will see if you submit for reimbursement. Some patients have concerns about confidentiality or how this may affect disability or life insurance. Many conditions, such as loss of a loved one, divorce, infertility, work stress, etc. represent an adjustment to a certain life stressor and are coded as such. At times I do see patients who do not have a mental health diagnosis, but rather, I feel their symptoms are a normal reaction to their life situation or stressor.

What if I believe my symptoms are not due to a mental health issue? How can you help?

Many symptoms are, in fact, due to what we call "organic" brain disorders, meaning you may exhibit symptoms of depression, anxiety, psychosis, etc. but the cause is an underlying medical illness, such as an autoimmune disease like lupus or hypothyroid, an infectious disease such as Lyme Disease, a metabolic abnormality like low sodium, a neurologic disorder such as epilepsy, etc. I have a particular interest in and expertise in this area, and especially with a new diagnosis or a "second opinion" consult, I am very careful to rule out all other possible causes before giving you a psychiatric diagnosis. At other times, there is a mental health issue that either the patient or the family is struggling to accept; in these cases, I will explain my rationale, provide psycho-education, and help to normalize your illness and destigmatize mental illness.

Is everything I say to you in session confidential? What happens if I see you outside the office, in a social or other setting?

All information you provide is confidential and cannot be released without your written authorization, with the exceptions of child or elder abuse, or threats to harm another. At times, it is highly possible I will see you outside the office; in these settings I will not approach you but will speak to you if you come to talk with me, though prefer to leave any confidential matters for office, phone or email.

How do I reach you if I am a new patient?

If you call 858.876.2333 or email me either through my website or at drwakil@sdwellnessmed.com (both are protected for your privacy), I will give you a call back within 48 business hours. For directions to the office, please click Locate Us.

Forms for New Clients

Please complete these forms prior to your initial consultation. Both the forms themselves, as well as a short description of each of the forms, are provided here.

You may complete and sign the documents electronically (click icons). We use digital signature software which complies with the ESIGN Act. All the documents signed or sent through this method are thereby admissible in a court of law.

• For new patients, please click here to complete and sign all required New Client Documents electronically

You may download the forms individually in PDF format (click icons), print and fill them out, then either scan and email them to drwakil@sdwellnessmed.com or bring them to your initial consultation.

If you are having difficulties with the forms, we can email the digital signature request to you or provide a copy at the time of your initial visit, in which case we request arriving 15 minutes early to complete all the forms. Dr. Wakil will review these and answer any additional questions you may have.

Request New Patient Documents

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Patient Forms:

• Practice Information and Treatment Authorization
  This form provides you with information about treatments that may be offered to you, including psychotherapy and/or medication(s) as well as office policies. Please read the information carefully, and sign the authorization prior to your first visit at SD Psychiatry and Wellness.
• Patient Information
  This form provides your doctor with more information about you, your reasons seeking treatment, and other relevant details prior to your first visit.
• HIPAA Patient Privacy Notification and Receipt
  This serves as your notification of your rights to privacy, the Health Care Information Portability and Accountability Act. Please sign and print out this notification and keep it for your own records, and bring a copy to your initial visit for inclusion in your chart.
• Consent for Release of Information
  Please fill out this form if you have another doctor or therapist, or friend family member, whom you would like your doctor to contact to obtain or give information about your diagnosis, treatment, prognosis, etc. You can specify to whom the information should be released, and what type of information can be shared. At SD Psychiatry and Wellness, we believe in close cross-collaboration between treating clinicians (i.e., having your psychiatrist and therapist discuss your care) and in coordination of your medical and psychiatric
• Credit Card Authorization
  When you make an appointment at SD Psychiatry and Wellness, Dr. Wakil reserves time for you in her schedule, and in return request that you fill out a credit card authorization form. Your card will only be charged in the event of a cancellation less than 24 business hours in advance of your appointment, or for any services rendered without payment provided at the time of service.
• Parental Consent for Minor
  This agreement outlines the terms and conditions of services to be provided to your child and attests your consent to his or her treatment.

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Contact Us

If you have any questions or comments, or if you want to learn more about the services we provide, please call us or complete the form below. If you do not hear from us within one business day, please call our office at 858.876.2333.

Note: Do not use this form in case of an emergency! If you are having a life-threatening emergency, please call 911 or go to your nearest emergency room. If you are an established patient, please contact the office directly at 858.876.2333. This form is for new and/or prospective patients only.

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