New Patient Policy Form

Full disclosure for current medication is required for effective treatment. If no or limited medication disclosure is uncovered and results in medication abuse, the appropriate referrals will be offered. Treatment will continue but these medications will not be prescribed. It is our policy that patients receiving medications from our providers have appointments at least every 3 months (unless the provider states otherwise) in order to obtain refills. Patients may call the office and leave a message for prescription refills. Refills are called in Monday through Friday only, during normal business hours. Please allow 48 business hours for all requests. If you have not had an appointment within the last 3 months, it is the providers discretion to fill your medications. Our office takes the prescription of controlled medications very seriously. An initial face-to-face appointment AND an in-office visit every 90 days at a minimum may be required by your provider, the DEA and/or the state where you reside. We will not make exceptions to local or federal regulations. If you are prescribed a controlled substance, appointments will be required for refills.

All fees are due at the time of service and payable by cash, check or credit card (Visa, MC, Discover). Checks should be made payable to “Riddle Psychiatry”. There will be a 35 dollar fee for any returned / “bounced” checks. All patients are required to keep an active credit card on file (used for missed appointments, phone appointments, late cancellations, administrative work, letters & family conferences). There are no changes to these policies when someone other than the patient is paying for visits. Additionally, paying for visits does not change confidentiality; a patient’s progress, medical record and any privileged information can still only be given with direct consent from the patient

Accounts that are delinquent may be sent to collections. We are unable to schedule or keep scheduled appointments if the balance on your account is beyond $200. It is the providers discretion if they will fill medications for clients with outstanding balances. It is extremely important to keep your account up to date to avoid any delay in your treatment. We have the right to dismiss patients from our practice due to non-payments.

The fee for missing an appointment is $75.00 for a follow up and $200 for an initial evaluation (all fees and charges subject to change). Once an appointment is scheduled, this time is reserved for only you. In order for us to see all of our patients at the scheduled time, it is extremely important that you arrive ON TIME for you appointment. If you miss an appointment, you'll need to reschedule. If you do not show up or call within 15 minutes after your scheduled time with an estimated arrival time, you will be charged for a NO SHOW. This policy also applies for tele-medicine and tele-therapy appointments. If you are unable to keep an appointment, please give 48 business hours advanced notice (excluding weekends and holidays), otherwise you will be charged in full for the time that was reserved for you. Insurance companies do not reimburse for missed appointment charges. You may cancel your appointment by calling the office and leaving a message. Refill request may not be honored if follow-up appointments have not been kept. Please note that, while all of our providers try extremely hard to run on schedule, unexpected issues sometimes arise and a client needs more time than scheduled. Please be patient with our office staff; we are unable to predict when and if your provider will be running later. If you are unable to stay for your appointment due to provider lateness, we will be happy to reschedule.