NEW APPOINTMENT & OFFICE POLICIES

• A legal guardian must be present for clients under the age of 18 years old. Parents, care givers and significant others should attend appointments with the client. A Medical & Mental Health Records Release should be completed with any responsible person’s information, to assist in care.
• Any treatment or medication change will be discussed at your appointment only. If you are having side effects, please contact the office to obtain directions and to schedule an appointment. IF YOU ARE HAVING LIFE THREATENING DIFFICULTIES, PLEASE CALL 911 AND GO TO THE NEAREST HOSPITAL.
• There are two types of appointments offered at Jamestown Psychiatric, P.C, in – office and Tele-psychiatry. Tele-psychiatry is only offered to stable established clients or in some circumstances at the discretion of the provider. It is the client’s responsibility to know their insurance coverage for appointments and is responsible for payment.
• Please arrive or log in 15 minutes prior to your scheduled appointment time. Late arrivals will be rescheduled. Please bring your insurance card(s) and your medications or a list of your medications with you to all of your appointments. You may be asked to complete a questionnaire or to provide an urine specimen before your appointment time. Regular attendance for appointments is mandatory. “No show / Missed” appointments are not an acceptable way of sharing in your treatment plan. You must take responsibility for maintaining communication with the provider regarding your health and treatment. No show appointments will be billed to the client at $50 and will need to be paid prior to being rescheduled. First Missed Appointment with an acceptable explanation - client will be billed the No Show Fee and rescheduled. Second Missed Appointment – client will be billed the No Show Fee and rescheduled with the understanding that with the- - - Third Missed Appointment, client will be billed the No Show Fee and the client will be dismissed from the practice. Provisions for non-controlled medication will be made, allowing thirty (30) days for locating another provider.
• Cancellations must be made a minimum of 24 business hours prior to your appointment. Failure to do so will result in a charge to the client at $50 and will need to be paid prior to being rescheduled.
• Late arrivals (any time after your scheduled appointment time) will not be seen at their appointment time. If a later appointment slot is open the patient may be rescheduled to that time slot. If no other time is open or the patient does not want the next open time slot that day, this will be considered a no show and will be billed to the client at $50. Plan on arriving at your appointment 15 minutes early.
• New Client No Shows – the No Show Fee will be billed directly to the client’s credit card at half the rate of the appointment type scheduled. They will not be rescheduled.
• Payment is due and required at the time service is rendered. It is your responsibility to provide the office with up to date insurance information. If you are unable to make payment at the time of service, it is your responsibility to make alternate arrangements with the office. Credit card information may be placed on file for your convenience. Failure to make payment or alternate arrangements may lead to dismissal from the practice and possible legal action. Returned checks due to insufficient funds will result in a $35 charge to the client.
• Non-controlled and Controlled prescription requests from clients will require 24 business hours. The request will be reviewed for accuracy of medication, strength, dosing, and frequency of appointments. The request will be forwarded to the provider for completion either by electronic prescribing to the client's pharmacy on file. Early fills will not be approved. Clients will be required to be seen by the provider at least every three months to receive controlled prescriptions or at the discretion of the provider. In accordance to state law, iStop will be checked for every controlled prescription, reviewed for duplicate prescriptions and other conflicting prescriptions ordered by other providers, compliance and then reported to the provider and NYS if required and documented in the client’s chart.
• In some instances, Client’s that are prescribed controlled substances may be required to sign a “Controlled Substance Contract”. This contract may be required at the beginning of treatment or any time thereafter per the provider’s discretion. The client is informed that unannounced urine or serum toxicology specimens may be requested and their cooperation is required. They must understand presence of unauthorized substances in urine or serum toxicology screens may result in their discharge from Jamestown Psychiatric, P.C.
• Jamestown Psychiatric, P.C. has a “Zero Tolerance Policy” in regards to disrespectful behavior. If a client presents to the physician / provider / office staff or any other client, in a threatening, aggressive or vulgar behavior, the client will be asked to leave the premises and will no longer receive treatment from Jamestown Psychiatric. P. C. At the discretion of the provider, law enforcement may be called and if law enforcement officials are needed to respond, Jamestown Psychiatric, P.C. will pursue legal charges to the fullest extent of the law.

This notice was published and becomes effective January 01, 2008, updated February 17, 2010, updated January 01, 2013, updated February 01, 2015