Treatment Agreement

Please review the following information regarding the general policies in place regarding treatment. If you have questions or concerns regarding any of the policies, please wait to sign until we can discuss the issue further.


Policies regarding scheduling, rescheduling, and cancelling appointments….
I am limited in when I can see patients by the clinical office hours that I have. Subsequently, the clinical time that we have scheduled for our appointments or sessions is of the utmost importance for both you and myself to keep, as rescheduling is more difficult with the limited number of hours I have to work with. I will always start and end our sessions or meetings at the appointed time, regardless of when you may arrive for your appointment, so it is recommended that you are ready for your appointment with the latest update of Zoom several minutes before the session is set to begin. I will send a link in the minutes leading up to the appointment


I maintain a strict 48 hour cancellation policy. If you attempt to cancel your appointment less than 48 hours before your scheduled appointment, I will charge you for your session, and it is exceedingly unlikely that your insurance will reimburse the time. If you desire, I will be available to conduct a session via phone during our scheduled day and time, which will be billed at the same nominal rate as an in‐office visit as an alternative to missing your session entirely. Conducting psychiatric care over the phone is never ideal and is only offered as a means to bridge your care to your next session with me.


Based upon the specific circumstances that lead to the cancellation and your history of attendance and compliance at other appointments, I may opt to provide you with a “free pass” for your first missed or cancelled appointment. This is entirely up to my discretion and in no way should be counted on or expected when missing or cancelling an appointment.


Despite the strict 48 hour cancellation policy, I understand that there are some things in life that happen without notice and are of significant importance. The following will generally lead to excused (non‐billed) absences from our clinical appointments; illness (fever, vomiting, etc. severe enough to warrant missing work and other important daily aspects of your life), child/dependent’s illness, the death of a loved one, transportation issues (your car broke down, a plane flight was cancelled). The following WILL NOT constitute excused absences from our sessions: forgetting or misremembering the appointment date/time, general traffic issues, mild illness (colds, coughs, etc…),or not arranging for childcare.


Policies regarding billing and payment of services

I currently see patients through the BC/BS PPO panel, and patients opting to use this insurance will be billed utilizing BC/BS copayments and rates. Some patients may prefer not to utilize insurance to pay for their treatment. The following represent my rates for various services provided.


Medication management – 25 – 30 minutes ‐ $160
Psychotherapy – 45‐50 minutes ‐ $200
Initial Diagnostic Evaluation – 50‐55 minutes ‐ $275


If you become involved in legal proceedings that require my participation, the provision of my services is $400/hour for preparation and court attendance.


Phone calls – The phone should be used primarily as a tool to communicate simple requests (needing a refill of medication or scheduling a new appointment, although email is a preferred method of reaching me for these issues). A large portion of my training entails observation of patients in corroboration with their historical information (observing body language, behavior, eye contact, etc…). When I conduct clinical care over the phone, I am effectively taking away a large portion of what makes me an effective clinician, which is neither good for me nor for you as a patient. However, in some instances, there is no reasonable alternative to conducting a session on the phone. All phone calls lasting more than 10 minutes in length will be billed at a prorated rate of $320 / hour. This includes phone sessions conducted as an alternative to missing an appointment.


Copayments and Deductible payments for BC/BS PPO patients and the full fee for self‐pay patients is expected at the beginning of each session. I can accept payment in the form of credit cards (Visa, Mastercard, Discover, AMEX), Health Savings Account cards, and debit cards.


Medical Records – I maintain patient records to meet both the legal and professional obligations of a psychiatrist. You are entitled to a copy of the records. However, I would advise that with any request for medical
records that we schedule a brief period of time to go over them, as many of the terms and nomenclature used in the psychiatric profession are complicated and could potentially lead to a misinterpretation by a patient reading it.

Contacting Me
[email protected] ‐ this is the email attached to my business and work. Utilizing email is appropriate primarily for contacting me for initial appointments, scheduling or rescheduling appointments, informing me that
you require medication renewals, or communicating that there is a concern with your symptoms or treatment that you would like to discuss further via an appointment. Communication via email is my preferred form of communication as there is a record of the interaction that I can refer to. I check my email frequently, and you can expect a response within 24 hours of sending a request.

312‐224‐9831 ‐ This is my business phone number. You may use this number for scheduling appointments, informing me that you need medication renewals, or to communicate that you are having a non‐urgent concern
with your treatment or symptoms. I check my messages several times per day, and all messages left are also forwarded to my email account as a .wav file so I can check messages even when I am not near my business phone.

319‐321‐9481 ‐ This is my cell number. This should be used only for urgent issues. Examples could include an unexpected and seemingly serious medication side effect, or issues which seem like they could threaten yours or
others’ short term health if left unchecked. TRUE EMERGENCIES SHOULD NOT BE DIRECTED TO THIS NUMBER. If there is a current concern about yours or other’s safety or you feel that you are completely losing your ability to function, EITHER CALL AN AMBULANCE OR REPORT DIRECTLY TO THE NEAREST EMERGENCY ROOM. Time spent trying to contact me on the phone may interfere with receiving the urgent care that you require.