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DUTY TO COOPERATE: As a patient seeking treatment, you have a duty to cooperate with your Provider on your plan of care and treatment.


APPOINTMENTS: We require a notice of cancellation at least 24-hours in advance of any scheduled appointments.  There will be a $25 charge for any appointments cancelled with less than a 24-hour notice or a $50 charge for any no show appointments.  For testing appointments, these charges will apply per hour scheduled.  This charge is not billable to insurance and will be billed directly to the patient.  These charges must be paid on before a patient can be seen again.  Any patient that is a no show/late cancel for 3 appointments may be discharged from the practice.  Per Federal Regulations (HIPAA, Stark Law I, Stark Law II, and OIG), all copays are due at the time of service.  Balances are due at the time of service unless otherwise specified, or your appointment may have to be rescheduled to another day.  Please note, children under the age of 16 cannot be left alone in the waiting room at any time.  Children under the age of 16 cannot be left without a parent or guardian at the practice at any time.  Please be aware our office is monitored by security cameras in the common areas and outside of the building. 


MEDICAL RECORDS/FORMS: A valid health information release form must be signed by the patient or guardian prior to the release of any records, no exceptions.  We are unable to release any outside records that may be part of your medical file.  There is a 10 day turn time on all medical records and forms and a 3 day turn time on all patient requested letters. 



There is a charge for all forms and records, those charges are as follows:

  • $25 charge for patient medical records unless requested by a government entity

  • $25 charge per 3 pages for forms that need to be filled out by a provider or staff (maximum of $75)

This payment is due before the records can be released or forms can be completed.  Patient must see the doctor or nurse practitioner for at least 3 visits before any forms can be completed; the therapists/psychologists are unable to complete any forms. 


BREACH OF CONTRACT/DUTY TO COOPERATE: As a patient seeking treatment, you have a duty to cooperate with your Provider on your plan of care and treatment.  We reserve the right to discharge any patient from our practice who violates our office policies and procedures.  If you are discharged from the practice, you will receive a notice in the mail notifying you of this discharge.


PRESCRIPTION MEDICATIONS/REFILLS: In order to receive any psychiatric medications, you must be seen in the office.  If you miss your scheduled appointment, we are unable to refill any medications until you see the doctor again.  We DO NOT authorize early refills on any medications.  Please be aware that any prescription requests may take up to two business days to process.  Please be sure to call in your refill requests to our prescription line.  All medications are e-prescribed directly to your pharmacy.  Temporary supplies, a 90-day supply, and replacement prescriptions will not be given on any controlled substances.  If at any time we suspect you of abusing your prescription medications, you will be discharged from the practice.  If you receive duplicate medications from another physician, you will be discharged from the practice as this is in violation of our office policies and against the law.  Please be aware we do have access to the Georgia Prescription Drug Monitoring Program and check it on a regular basis.


PAYMENT FOR SERVICES: If you have insurance coverage, it is your responsibility to be knowledgeable and understand what your insurance plan will cover and your expected financial responsibility.  You should be certain to understand the process of obtaining referrals or pre-authorization if required by your benefit plan, the amount you will be required to pay (copay, coinsurance, deductible) and any dollar or visit limitation.  Payment is expected at the time of your office visit for all charges if no insurance is to be billed or for your copay/coinsurance.  If full payment (copay, coinsurance, late cancel and no-show fees) is not paid, you will be unable to be seen for your appointment.  We accept cash, money order, Visa, MasterCard and Discover.  We do not accept checks.


PARENT/PATIENT ABUSE: We would like our patients to know that we respect their need for a safe, friendly, and caring environment in which to receive care and that we will take steps when necessary to ensure that all visitors to our practice are prevented from experiencing any abusive or offensive behavior while they are visiting us.  We expect everyone at our practice – providers, staff, patients, and other visitors to behave in a civil, courteous, and respectful manner.  We do reserve the right to discontinue service to patients who are not compatible with our providers, staff or mission.  We consider the following behaviors to be incompatible with our practice:

  • non-compliance with medical recommendations, treatment plans and appointments

  • vulgar or abusive speech or threatening behavior towards staff, providers, or other visitors to our practice

  • abuse of our facility, equipment or supplies

  • wandering the clinical areas unescorted or otherwise violating patients’ privacy rights as outlined under HIPAA

  • disrespect for the needs of other patients visiting our practice

While the great majority of our patients and families to do not fall into any of these categories, we are required to advise all of our patients and families of our policy. 

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