Appointments & Cancellations

Each appointment time is reserved exclusively for a specific patient. Patients are asked to provide 24 business hours' notice if they wish to change or cancel an appointment. Business hours do not include weekends or holidays.

Missed appointments will be charged the full appointment fee. Monday appointments require cancellation before 5:00 PM on the preceding Friday.

Fees & Payments

Charges vary depending on the type of service provided. Please contact our office regarding current fees. Payment is due at the time of service.

Accepted Payment Methods:

• Visa
• Mastercard
• Check
• Cash

Telephone Access

During business hours, please contact the office staff for any questions. Because appointments are in progress throughout the day, messages are generally reviewed at the end of the business day.

Office staff can notify the doctor promptly regarding urgent matters. For medical emergencies or life-threatening situations, call 911 or visit the nearest emergency room immediately.

Medical Insurance

To provide the highest quality care, services are offered primarily as an out-of-network provider, with the exception of Blue Cross Blue Shield and Aetna.

After payment is received, patients will receive a statement containing all necessary information for insurance reimbursement. Any reimbursement from your insurance provider will be sent directly to you.

Patients are responsible for verifying their insurance coverage and reimbursement percentages.

Confidentiality

Communications between patients and mental health providers are protected by law. Information is generally released only with your written authorization.

Your consent allows:

• Professional consultation with other healthcare providers while protecting your identity whenever possible.
• Administrative staff to access necessary information for scheduling, billing, and quality assurance.
• Disclosure to health insurers or collection agencies when required for billing purposes.
• Protective action if a patient presents a serious risk of harming themselves or others.

Disclosure Without Authorization

Your doctor may legally disclose information in situations including:

• Court orders or legal proceedings.
• Government health oversight activities.
• Legal defense if a complaint or lawsuit is filed.
• Workers' compensation claims.

Mandatory Reporting

• Suspected child abuse or neglect.
• Abuse or neglect involving elderly or disabled persons.
• Threats of imminent harm to yourself or others.

Whenever possible, your doctor will discuss these situations with you before taking action and will only disclose information necessary to protect those involved.

For confidentiality concerns, please contact our Privacy Officer: Brooke White.

Professional Records

Your protected health information is maintained in medical records that include:

• Reason for treatment
• Diagnosis
• Treatment goals
• Medication information
• Medical and social history
• Treatment progress
• Billing records
• Professional consultation reports

You generally have the right to review or obtain copies of your Clinical Record.

Psychotherapy Notes are maintained separately and require your written authorization before they may be released, except as permitted by law.

Patient Rights

You have the right to:

• Request corrections to your medical record.
• Request restrictions on information disclosures.
• Receive an accounting of disclosures.
• Specify where confidential communications are sent.
• File complaints regarding privacy practices.
• Receive paper copies of privacy policies and related documents.

Minors & Parents

Parents generally have the legal right to examine a minor's treatment records unless treatment involves suicide prevention, substance abuse, or sexual, physical, or emotional abuse.

Because confidentiality is often essential to successful treatment, parents are generally provided with summary information rather than detailed therapy discussions.

Psychotherapy Services

Psychotherapy is a collaborative process that varies depending upon the individual needs of each patient. Successful treatment often requires participation both during therapy sessions and outside of appointments.

Therapy may involve discussing difficult experiences, which can temporarily result in uncomfortable emotions. However, psychotherapy frequently leads to improved relationships, healthier coping skills, solutions to personal challenges, and significant reductions in emotional distress.

Treatment recommendations will be discussed with you, and second opinions are always welcome if desired.

Acknowledgement

I have read, understand, and agree to the above Office Policy Statement.