Patient
Resources
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We are currently accepting new patients into our practice. Thank you for considering us. To become a new patient:
Make an Appointment
Download your patient forms online through the patient portal
When you come to our office for the first time as a new patient, we'll ask you to complete some initial forms, including an Authorization and Consent for Treatment form, if you were not able to download them from the patient portal in advance of your appointment.
To make sure there are no delays in care during your first visit experience, please arrive 15 minutes prior to your scheduled appointment to ensure your registration is complete before meeting with your new provider.
Remember to bring:
Your insurance card
Valid photo ID
List of current medications
Office co-pay
In an effort to respect the time of all of patients, our staff strives to stay on schedule so that other patients do not have to wait.
For patients who are delayed and arrive late for appointment, every effort will be made to see them the same day. However, wait times may apply, or appointments may need to be rescheduled.on text goes here
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Please visit insurance in the main menu to see a list of insurances with which we participate.
Payment Options
We accept cash, Visa, Mastercard, Discover, American Express, and personal checks.Card-on-File
We encourage patients to keep a credit card on file to make the checkout process easier, faster, and more efficient. You will no longer receive statements from us, but you will continue to receive your Explanation of Benefits (EOB) from your insurance carrier once your claim has been processed, detailing the charges and payments made on your behalf.At check-in we will scan the credit card of your choice, including your Flexible Spending Account (FSA) or Health Savings Account (HSA) card.
After your insurance has paid their portion, we will:
⬜ notify you via email of the balance owed
⬜ charge the balance owed to your card on file
⬜ email a receipt for the chargeYour credit card information will always be fully protected by our off-site, card-processing partner Elavon, and not on our computers, as required by industry standards (Payment Card Industry Data Security Standard – PCI-DSS).
Fees - Primary Care
No Shows and Late Cancellations
⬜ Missed Appointment $50
⬜ Missed Physical $100
⬜ Late Cancellation $50
⬜ No-Show $50
⬜ Missed Procedure $200Fees - Mental Health
No Shows and Late Cancellations
⬜ Psychiatry intake no-show or late cancellation $150
⬜ Psychiatry follow-up no-show or late cancellation $100
⬜ Individual therapy no show or late cancellation $100
⬜ Couples Therapy no-show or late cancellation $100
⬜ Primary Care New Patient no-show or late cancellation
⬜ Primary Care Follow-up no-show or late cancellationOut-Of-Network
⬜ New Patients, Total Charge or Minimum $200 Deposit
⬜ Established Patients, Total Charge or Minimum $150 DepositSelf-Pay
⬜ New Patients, Total Charge or Minimum $200 Deposit
⬜ Established Patients, Total Charge or Minimum $150 Deposit
⬜ Procedures, Total Charge or Minimum $200 DepositSelf-Pay - Mental Health
⬜ Psychiatry Intake self pay, $175
⬜ Psychiatry Follow-up self pay, $100
⬜ Individual intake self pay, $125
⬜ Individual follow-up self pay, $100
⬜ Couples intake self pay, $150
⬜ Couples follow-up self pay, $125 -
⬜ Notice of Privacy Practices (PDF) - Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
⬜ Authorization for Release of Medical Information (PDF) - Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
⬜ Authorization and Consent for Treatment (PDF) - All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility. Autorización y Consentimiento Para el Tratamiento
⬜ Preferred Contacts (PDF) - Patients are encouraged to complete and return the Preferred Contacts Form but it is not required. Contactos Preferidos
⬜ Financial Policy (PDF) - This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
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⬜ Notice of Nondiscrimination Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
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