CARD ON FILE

A card on file is required. We keep a payment method on file for every patient so balances, no-show fees, and self-pay charges can be settled promptly. This applies whether you book with us directly or through one of our billing partners.

APPOINTMENT CANCELLATION & NO-SHOW POLICY

We require at least 24 hours’ notice for all cancellations. If you miss your appointment or cancel with less than 24 hours’ notice, your account will be automatically charged the following fee:

  • Missed New Patient Intake / Evaluation: $100
  • Missed Established Patient Follow-Up: $50

Please note: Cancellation and no-show fees are billed directly to the patient and cannot be submitted to or paid by insurance.

OUTSTANDING BALANCES & NON-PAYMENT POLICY

Accounts with balances more than 30 days past due will receive an electronic or mailed notice indicating that full payment is due immediately. Partial payments are not accepted on overdue balances.

If a balance remains unpaid, your account may be referred to a collections agency, and you and your immediate family members may be formally discharged from the practice. If a discharge occurs, you will receive a 30-day notice via mail or email to ensure you have sufficient time to secure alternative medical care.

DOCUMENT, PAPERWORK & MEDICAL RECORDS FEES

Administrative tasks and complex paperwork require dedicated clinical time outside of sessions.

Disability & Accommodation Paperwork Guidelines:

  • Established Patients Only: Providers will only consider completing paperwork for established patients who have been actively remaining in care with our practice for more than 3 months. We do not complete paperwork for new patients.
  • Exclusions: Our providers do not complete Long-Term Disability paperwork or Serious Mental Illness (SMI) documentation under any circumstances.
  • Forms & Letters: FMLA, Short-Term Disability, & Accommodation Forms/Letters are $35 per page.

Medical Records Requests:

  • Coordination of Care: No charge for records sent directly to another healthcare provider, facility, hospital, or insurance company.
  • Patient Requests: No charge if delivered electronically.
  • Third-Party Requests: Law Firms, Disability Agencies, etc. are charged $40 for the initial 100 pages, and $0.10 per page thereafter.