NEW CLIENT Information
RELEASE of Information
NO SHOW Policy
Tips for a smooth visit.
Please download and read NOTICE and TESTING information.
CONSENT FOR CHILD Under 18
NOTICE of Privacy Practices
• Arrive 15 minutes early for all visits.
• Bring your insurance card to your first visit and provide updated insurance information each time there is a change. If you do not provide a copy of your insurance card you will be considered a self pay and required to pay the self pay rate in full on the day of your visit.
• Bring any pertinent records from schools or other providers.
• Have a complete list of all the client’s current medications and a list of any psychotropic medications previously prescribed.
• Be prepared to pay your copay or full amount of self pay rate.
• If there are any custody arrangements through the courts we will need a copy of the court decree to keep on file. It is the client’s responsibility to keep us informed of any custody changes.
• Make sure a parent or legal guardian attends the first appointment and signs a consent for any other adult to bring the child.
• We cannot speak to anyone on your behalf unless there is a signed Release of Information on file. This includes a spouse or parent of and adult (18 years or older) who is checking on an appointment or balance. We are more than happy to work with a relative or friend on your behalf but will require a signed Release of Information prior to providing any information. If you would like to add someone to your account please ask about a Release to keep on file. You may choose to limit that Release to appointments or billing only.
• All new clients for psychiatry require a referral from the most recent treating psychiatrist. If you have never seen a psychiatrist we will also accept a referral from your primary care provider.
• Many insurance companies are requiring referrals for services so you may be asked for this prior to scheduling an appointment.
• There is a $25 No Show fee for all appointmetns missed without a 24 hour notice.