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Policies and Forms

Policies

Appointments: 
  • New patient appointment are scheduled for 90 minutes. 

  • Follow-up appointments are either 20-25 minutes or 45-50minutes long.  The session length should be determined when scheduling the appointment.    â€‹

  • A 24-hour cancellation notice is required to avoid a charge for this time.

  • Cancellations for a Monday appointment should be made no later than Friday morning.

  • If you are ill or have another emergency please notify the office as soon as possible at 615.864.0992

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Fees and Insurance:
  •  I am an "out of network provider," which means that I do not contract with insurance companies and can not submit claims on your behalf.

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Good Faith Estimate: 

  •  You have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost.  

  • You have the right to receive a Good Faith Estimate of the bill for the total expected cost of any non-emergency items or services (appointments, prescriptions, etc)

  • The Good Faith Estimate should be provided to you in writing at least 1 business day prior to your medical service.  You can also ask for a Good Faith Estimate before your schedule an appointment or service

  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.  Therefore, keep records of your Good Faith Estimate.

  • For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov.nosurprises or call 1-800-985-3059

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New Adult Patient
Information Form

Forms 
 

New Child/Adolescent Patient
Information Form

Health Information Release

Privacy Practices Acknowledgement Form

Patient Payment  Agreement Form

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