We hope that your day is going well!

Here you will find the following documents: 

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1) New Intake Documents

• Complete prior to your first appointment

• E-mail/fax to the office or bring it with you to your appointment

2) Consent for Release of Information 

• Complete prior to your first appointment or as needed to allow us to request medical records from your other provider (labs, radiology results, etc)

3) Consent for Treatment (full version for review)

4) HIPAA Policy  (full version for review)

5) Insurance Policy (full version for review)

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Updated Office Policies (9/16/25): 

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SCHEDULING APPOINTMENTS

When booking your appointment, in the comments box, please include the reason for your visit, your date of birth, and insurance name with member ID number and group number (if applicable). Prior to your initial appointment, please fill out your new client forms in the patient portal, prior to your scheduled appointment. If your appointment is in person, please arrive 15 minutes prior to your appointment to complete paperwork. New client forms will be emailed to you through your secure patient portal called Patient Ally once your appointment has been confirmed. Be sure to check your spam folder.

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PAYMENTS

The total cost of the appointment or the initiation of a payment plan is due at time of service. Payment invoices for co-payment or full payment will be sent to the email you provided to us from Square. If you miss a payment, we reserve the right to cancel your next appointment until payment is received.  An active credit card must be kept on file.

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TIMELINESS

We reserve the right to cancel your appointment if you are more than 10 minutes late.  Allotted appointment session times are shared with you in your confirmation email. Appointments will end on time. If additional time is needed, the provider can inform you if time is available during your appointment as this varies based on booked appointment times.

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REFILL REQUEST

Medications will be refilled at each appointment.  Refill prescriptions will be called in for current patients who maintain their scheduled visits.  Please allow 24-48 hours for refill requests between appointments.  Emergency refill requests are not available. Prescriptions will not be called in after operating business hours or during holidays.  Prescriptions will not be refilled for anyone who repeatedly misses their scheduled appointments. 

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CANCELLATION POLICY

If you miss your appointment, you will be charged $75 dollars. To avoid this fee, please cancel your appointments at least 24 hours prior to your appointment. 

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PATIENT PORTAL

After you have completed your appointment request, you will be sent a link to our secure, online patient portal named Patient Ally.  There you can view your current medication list, past visit summaries, and message the provider for requested refills or non-urgent medical concerns or side effects that may be occurring. 

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CONTROLLED MEDICINES

These medications will not be refilled if appointments are missed. They will not be refilled in between appointments . This includes medications for ADHD. If prescribed a controlled medication, a formalized plan will be in place to discuss time frame use and treatment options for non-controlled medications to be considered. You agree to random drug screen testing when being prescribed controlled medications. If misuse or abuse is suspected, we reserve the right to cancel your prescriptions.

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