The following has been prepared in order to facilitate our work together. Please read this document carefully, and communicate any concerns so they may be addressed immediately.
Confidentiality
The law, professional ethics, and common sense require that all information disclosed within sessions is confidential and may not be revealed to anyone without your written permission. There are, however, some exceptions to the rule where disclosure is required by law: where there is a reasonable suspicion of child, dependent or elder, abuse or neglect; where a patient presents a danger to self, to others, to property, or is gravely disabled, or when required by a court of law. Insurance Providers (when applicable) and other third-party payers may be given information related to services rendered. More details are available upon request of our Notice of Privacy Practices.
Patient Portal: Registration and Online Scheduling
All scheduling is completed online. To schedule, patients are required to use the calendar of the online portal “Patient Ally”, which can be accessed through our website or at www.PatientAlly.com, in lieu of contacting us by phone. Your cooperation leaves us more available to tend to more important aspects of your care. If necessary, you may request appointments by calling (760) 650- 2290 ext. 2001 during business hours.
When registering with the portal, you will receive an email from Patient Ally with a link to the portal. Once you create an account, complete any paperwork under the “Documents tab”. Call us if you have difficulty using Patient Ally.
Follow-up appointments will be confirmed within 1 business day in the portal. Request to reschedule or cancel appointments through the messaging feature of the portal.
Be aware that both Dr. Arora and Dr. LaMarca practice in more than one office location, which is specified in their calendars on Patient Ally. You are responsible for ensuring you are scheduling in the correct location. For your convenience, you may receive optional appointment reminders through our automated system via text, email, or phone call. You are responsible for also marking your appointment times on your personal calendar, however, as the automated reminder system may not be reliable. Please use Patient Ally to keep your information up to date. Send us a message to update your home address, phone number, insurance, and emergency contact information as needed.
Contact Procedures
Phone: For non-emergency matters, contact us by phone at (760) 650-2290. We typically respond within 1-2 business days during normal business hours. Messages left after 5 pm on Fridays will be returned at the beginning of the next week. If there is limited unscheduled telephone consultation of an urgent matter with our doctors between normal sessions, and it is 10 minutes or less, then there will be no charge. However, please bring any concerns related to your treatment to your scheduled appointments.
Portal: Please use the portal to request appointments or message us regarding routine communications.
Email/Text/Social Media: We do not accept communication outside of our phone or patient portal procedures under any circumstance. Contact by social media platforms is discouraged. You may use the portal to message staff or exchange documents regarding routine matters. Please reserve issues of a clinical nature for your face-to-face sessions with your providers.
Emergency procedures: In the case of an emergency, call 9-1-1 or go to the nearest emergency room.
Payment for Services
Payments for services are due at the time the service is rendered or a charge is incurred. Our fees are periodically raised with reasonable advance notice. Please notify us if any problem arises during the course of our work together regarding your ability to make timely payments. If you have not remit payment for outstanding balances or set up a fee payment plan within 90 days of charges, your account will be sent, with reasonable notice to you, to a collection agency. You may request a receipt or detailed statement of charges or summary of your payments at any time.
A holder of this medical debt contract is prohibited by Section 1785.27 of the Civil Code from furnishing any information related to this debt to a consumer credit reporting agency. In addition to any other penalties allowed by law, if a person knowingly violates that section by furnishing information regarding this debt to a consumer credit reporting agency, the debt shall be void and unenforceable.
Your bank statement may include a charge that states, LUCIDITY SP. If you mistakenly initiate an unauthorized chargeback request, you will be charged the fee again, plus any fees acquired for the error, plus an additional $25 administrative fee. You then have 10 business days to re-submit payment for that service. Otherwise a late payment fee of $25 for each unpaid charge will be incurred.
By initialing below and signing this form, I, the patient (or the patient’s representative), acknowledge that payment is due at the time a service is rendered or a charge is incurred. I acknowledge these charges may include fees for missed appointments, late cancellations, or late payment fees.