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Office Policies

Completion of Forms:

Services provided outside of regular medication follow-up or psychotherapy visits may be charged at an additional rate. In general, additional fees are based on the amount of time a clinician needs to spend on your request. Your insurance pays for your medical and therapeutic treatment. For example, it does not cover time spent interfacing with school personnel, drafting letters, or completing medical leave or disability claim forms. At the discretion of your practitioner you may be billed for these services and will be informed in advance of these charges. You have the right to rescind your request for these services if you so choose. Please note that medical leave and/or disability claim forms are only completed for clients that are well-known to this practice/provider. Keep in mind that diagnosis of a mental illness is not necessarily equivalent to disability or functional impairment. An individual who has major depressive disorder is not legally disabled if he or she can engage in “substantive gainful activity.” Substantive gainful activity refers to a level of activity that SSA uses to establish disability. As a rule of thumb, a disabled individual should not be able to participate actively in the national economy. There is a $15 per page (in advance) charge for all forms or drafted letters that need to be completed by the provider. During your form completion or letter drafting, the provider is not able to engage in direct care. The time spent can range from 10-60 minutes and is not billable to your insurance, therefore this expense is the responsibility of the client and/or their responsible party. Due to the high volume of forms we receive, please allow us 5-7 business days to return forms back to you. Please read all forms before submitting them to us. Please fill out all portions of the parent’s section, especially any medication your child is receiving from another provider. All forms need to include instructions as to where to send the forms once completed, along with a self-addressed stamped envelope if they are to be mailed.

Phone consults:

If you are an established client and you have a question(s) or concern(s) about your treatment plan, medication, and/or onset of symptoms, please speak with office triage personnel. Triage personnel will answer all questions within the scope of their training, but seek advice from the providers during the interim. If necessitated, triage personnel may also return your phone call with the provider's advice. When your question or concern has followed this appropriate channel and you still seek to speak directly to your provider, then please tell the triage personnel you would like to schedule an appointment with your provider.

Medication Refill Policy:

You must notify your provider during your face-to-face visit if you need a prescription renewal. Our provider will write enough prescription to last until your next appointment. No medication refills will be called in after hours or on the weekends. Refills for missed appointments, no shows or lost prescriptions will not be completed. Use of our

Emergency Telephone System:

The Clinician/Therapist or one of their associates is available daily for emergency telephone contact. He/she can be reached through our office or the on-call service. Please give the service your name and inform them that it is an emergency. We value your contact in real emergencies as it may smooth your treatment or help prevent unwelcome hospitalization. However, routine clinical updates or questions should await your session.

After hours/ weekend emergency phone number is: 980-285-7287.

Record Transfers:

If transferring to our office from another practice, please request the records be released to our office before your first visit in our office. If transferring out of our office, please download, complete and submit our Authorization_to_Disclose_Information The form should be signed by the parent or legal guardian if the patient is under 18 years of age and by the patient them self if over the age of 18. There is a $25 fee (per 5 pages) for the copying and releasing of medical records that is due upon submission of the request.

Missed Appointments / Late Cancellations:

If you are unable to keep a scheduled appointment, call the office a minimum of 24 hours ahead to cancel or reschedule that appointment. Failure to cancel your appointment without 24 hour notice will result in a $25 fee. Failure to cancel your appointment without 24 hour notice may also result in discharge from this practice. Please see our Cancellation Policy within your forms on our Helpful Forms page.

 Co-payments and Insurance Cards:

At every office visit, be prepared to show your current insurance card and make a co-payment if your plan requires so. If your child is sent with a childcare provider, please make sure that that person is prepared to make the co-payment and show a photo I. D. Identification: For all clients and/or their legal guardians, a state issued photo I. D. is a mandatory requirement in our practice or your appointment will need to be rescheduled.

Walk-In Appointments:

All visits in our office are by appointment only. Please call the office and we will make every effort schedule you the earliest appointment. Late to Appointment: If you are more than 15 minutes late to your appointment you will need to reschedule. Video Cameras or Voice Recording in Exam Rooms: For the privacy of our patients and our employees, we do not allow videotaping or voice recording in our office. Thank you for respecting this policy.
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Helpful Forms

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