Contacts and Appointments

  • Privacy Notice

    This contact form is for initial appointment inquires.
    E-mail is not a secure form of communication and does not protect your privacy.
    Please do not use this form or e-mail to cancel an appointment or to send confidential information.
    To cancel or reschedule an appointment, please call my office at: (707) 579-9457.
    Please send confidential, personal written inquiries, requests for records or concerns about psychotherapy services, by US Mail or by fax. My fax number is (707) 703-5334.
    You can also call my office during business hours 8:30 AM - 5 PM Tuesday - Thursday.

  • How to make an appointment

    To schedule an initial appointment or get more information about my services, please call or email.

    The best times to reach me directly by phone are
    Tuesday - Thursday from 9:30 - 10:00 AM and 1:00 - 2:00 PM.

    You can leave me a confidential voice message any time. I will return your message within one business day.

    I schedule appointments
    Tuesday - Thursday from 10:00 AM - 5:00 PM

    Andrew M. Leeds, PhD
    Licensed Psychologist PSY10471
    1049 Fourth Street, Suite G
    Santa Rosa, CA 95404
    (707) 579-9457 Phone
    (707) 703-5334 Fax

    I have administrative staff support to assist you with your questions
    Tuesday - Thursday from 8:30 AM - 1:30 PM.

  • Office Forms

    On this page you can download the forms you will need for your initial appointment.

    If you prefer, we will gladly mail your paperwork to you in advance. Just ask when you schedule your appointment.

    Or you can plan to arrive early and fill out the forms in the waiting room.

    The first three forms below are all required.
    The fourth item, the HIPPA Notice of Privacy Policies is for your reference only and need not be printed.
    NewPatient.pdf
    1. All new patients must complete the two-page form above.

    OfficePolicies.pdf
    2. All new patients must read and initial the bottom of the two-page form above.

    HIPPAPrivacySignature.pdf
    3. All new patients must sign the form above stating you have had the opportunity to read our HIPAA privacy practices form #4 below.

    PrivacyPractices.pdf
    4. All new patients have the right to read our HIPAA privacy practices form. You do not have to print this form or bring it.

    InsuranceRelease.pdf
    5. Patients with Medicare or Crime Victim Program coverage must complete the Insurance Release form above. Other patients who wish us to submit insurance claims on your behalf may also sign to release claim information. We accept direct payment from from Medicare and Crime Victim programs. For all other plans reimbursement is sent to patients.

    ReleaseRecords.pdf
    6. This optional form is used to obtain prior records or to allow Dr. Leeds to share information with other professionals or health care providers.

    TelehealthConsentForm.pdf
    7. This optional form is used to to allow you and Dr. Leeds to conduct sessions via a secure videoconference service such as Doxy.me or Zoom.

  • Location and Directions

    Andrew M. Leeds, Ph.D.
    1049 Fourth Street, Suite G
    Santa Rosa, CA 95404

    (707) 579-9457 Phone
    (707) 703-5334 Fax

    Administrative staff hours
    Tuesday - Thursday from 8:30 AM - 1:30 PM.

    Psychotherapy hours
    by appointment.
    Tuesday - Thursday from 10:00 AM - 5:00 PM.

    View location and get directions on Google Maps.

    Driving directions
    From Highway 101, take the College Avenue exit East 1 mile to Fourth Street. Go right on Fourth Street about 1/2 block, turn right into our driveway. Parking is available at the rear of building. The entrance to Suite G is on the West side of the building.

    Arrive Early for First Session
    Please plan to arrive 20-30 minutes before your first appointment to allow yourself sufficient time to complete your paperwork and review our written office policies. We will gladly mail your paperwork to you in advance. Just ask when you schedule your appointment. Or if you wish, you can download and print out the forms you will need from the Office Forms section (above).