Please fill out this New Patient Application form is you want to become a patient of Dr. Jeider. All applications are screened for appropriateness before and initial evaluation is offered. After that initial evaluation, a collaborative decision will be made if you and Dr. Jeider are a good fit for treatment. Being approved for an initial evaluation does NOT constitute an ongoing doctor patient relationship.
Application fee is $25 and due at time of application submission. If approved for an initial evaluation, you will be credited the $25.
Initial Consulation will be scheduled for 60 minutes. The appointment can either be virtual or in person (office is located at W. Twain Ave. and 215 in Las Vegas, NV). The cost is $500.
If it is mutually agreed to establish an ongoing doctor patient relationship, subsequent appointments will be 30-60 miuntes depending on your clinical needs at an hourly rate of $400.
You agree to have a credit card on file and to be automatically charged for any appointment not cancled withing 72 hours. If you "Late Cancel" or "No Show," you agree to the full charge of the time scheduled.
Payments will be processed online with a credit card kept on file to automatically charge 72 hours before any schuduled appointment.
INSURANCE IS NOT ACCEPTED AT THIS PRACTICE
Please click one of the PayPal options to complete payment and submit the form.