At Dove Psychiatry, PLLC, we welcome you as part of the family and are honored to be a part of your mental health journey. Please read the consent and policies carefully, it contains important information about our professional services and business policies. Before signing, please feel free to ask us any questions. After signing, it will constitute as a binding agreement between you and Dove Psychiatry, PLLC.
We will not tolerate any rudeness or disrespect to our staff or providers, This is defined as cursing, yelling, throwing tantrums/objects, or threatening bodily harm or damage to provider, staff, or other patients in the office. Dove Psychiatry-NP, PLLC, we are very respectful and empathetic, and hold the same high expectations of you. If you are disrespectful, or continuously miss/cancel your appointment more than 2 times than you will be terminated from the practice and we will refer you to a different provider.
Although I incorporate some talk therapy into our sessions, please be aware that I am not a therapist, or specialize in talk therapy, unless you and I have discussed alternate options. I will gladly provide you a list of referrals to therapists so that you may have as many tools as needed to help you progress in your mental health journey.
Follow-up appointments at Dove Psychiatry-NP, PLLC, are comprehensive, including not only assessments and psychiatric evaluations but also emotional assessment tools. For this reason, psychotherapy is always part of our sessions. During these sessions, we will discuss your medication regimen, address any concerns, send your refills to your preferred pharmacy, and document our session. It is imperative to arrive 5 to 10 minutes early to ensure we capture all your concerns and provide the dedicated care you need to succeed.
Prescription Refills:
If you need refills because you missed your last follow-up, please schedule a follow-up as soon as possible. For any medication changes, or refills it is required by NY State Law that you would need an appointment with your provider. A 14 day supply of medication is the allowed max refill as you schedule your follow-up appointment. For controlled substances, you must be seen for refills on a monthly basis and have one in person every six months. There are no exceptions.
Please allow your provider 72 hours to send refills and answer any questions. If it is an emergency, please go to your local ER or call 911, as we are not an emergency clinic nor do we provide crisis intervention or emergency services. Messages will be responded to during working hours, only. Any messages received after 3PM on Friday will not be responded to until the following business day, Monday. (If it is not a Federal Holiday).
Credit Card On File Policy:
Dove Psychiatry, PLLC, is dedicated to making our billing process as easy as possible, for you and for our staff. When scheduling your first appointment, it is required to leave a credit or debit card on file to cover fees related to copayments, and any outstanding balances for services rendered, such as, deductibles, co-insurance, same day cancelation fee, no show fee, any medical documentation, or if you are on a private payment plan. We accept all credit cards, FSA, HSA, and debit cards. Your card will be charged for any balances on a bi-weekly basis per our payment plan, $50 initial and $30 bi-weekly until balance is 0.
The card that you save on file will be charged on the Friday before your appointment,unless we are told via email to collect the co-pay the day prior to your followup. This policy is to ensure a smoother day for both staff and patient the day of your appointment. Failure to pay your balance within 14 days, will constitute your balance being sent to collections and termination from the practice. Please be cognizant if your card becomes expired, or if there is an error with your card, it is your responsibility to provide a new form of payment.
If your insurance determines you are responsible for additional charges, such as co-insurance or a deductible, your card will also be charged 7 days after a statement is emailed to you.
It is the responsibility of the client to make sure Dove Psychiatry, PLLC, has your correct email address and the patient checks the given email address for emailed bills.
If you do not agree to the balance on the statement, you must call our office during our hours of operation at, 631-881-4569 to contest the balance within 7 days. All self-pay appointments must be paid for at time of booking. Members paying through their insurance must email or text a copy of the front and back of their insurance card to dovepsychiatry624@gmail.com within 48 hours from the time the appointment has been scheduled to avoid appointment cancellation.
During the time you leave a credit card on file, if it expires or otherwise becomes
uncollectable, we will expect you to promptly provide a new means of payment. Credits on your account after your insurance claim has been adjusted will be returned to the credit card on file or used as a credit towards your following appointment. Ultimately, you are responsible for knowing what services are covered, how often, and how much of the cost is your responsibility. You will be responsible for any portion of services that your insurance does not cover.
To avoid any issues of discrimination or favoritism; all patients will be required to
have a credit card on file regardless of insurance or visit type.
The copayment amount is determined by your specific insurance plan. Dove Psychiatry, PLLC, has no control over the cost of your co-payment. If you will not be able to pay the copayment at the time you receive care or services, you will need to call ahead to see if you will be able to keep your appointment. You, as the client, are responsible, for all or part of the charges not covered by your insurance, based on your coverage and insurance plan.
No-Show and Same-Day Cancellation Policy:
We understand that situations can arise unexpectedly. However, due to the high demand for appointments and to ensure we can accommodate all our clients effectively, we have implemented the following policy regarding missed or canceled appointments:
Cancellation Notice: We require a minimum of 48 hours’ notice to cancel or reschedule an appointment. This advance notice allows us to offer your appointment slot to other clients who may be waiting.
Fees for Late Cancellations and No-Shows:
Intake Appointments: $95
Follow-Up Appointments: $75 after the first show
These fees are necessary to cover the cost of reserved time and to help manage our schedule efficiently. We appreciate your understanding and cooperation.
To cancel or reschedule an appointment, please contact us as soon as possible. If you have any questions regarding this policy, feel free to reach out to our office.
Thank you for your consideration and for helping us serve all our clients better.
Telehealth Consent:
I. Teletherapy is the delivery of psychological treatment and consultation provided through interactive internet technologies where the patient and the clinician are not in the same physical location.
II. Clients are expected to attend psychiatric sessions regularly and require a minimum of 48 hours notice for cancellation and reschedule.After two no-shows you will receive a warning letter, and after a third no show, you will be discharged with a 30 day supply of medications.
III. A lack of access to the information that might be achieved in a face to face visit but not in a telehealth session may result in errors in psychological judgment.
IV. There might be a risk of deficiencies, delays or failures during the transfer of services due to electronic circumstances.
V. Telehealth does not provide emergency service.
VI. All information provided will be held confidential and will not be disclosed without permission, except where disclosure is required by law. The electronic systems that are used throughout the service incorporate network and software security protocols (encryption) in order to protect the confidentiality of the patient information and data.
Protection Of Patient Information:
At Dove Psychiatry, PLLC, we are committed to protecting the privacy and confidentiality of our patients' information. This includes any personal details, medical records, and communication preferences. We strictly adhere to all relevant laws and regulations to ensure your information remains secure.
SMS Opt-In and Phone Number Privacy
We understand the importance of your privacy. Therefore, we want to assure you that we do not share or sell any phone numbers or SMS opt-in details for the purpose of marketing or any other non-clinical activities. Your phone number and any communication preferences provided to us are used solely for the purpose of facilitating your care and ensuring effective communication between you and our practice.
HIPAA-Compliant Communication
The platforms and tools we use for communicating with our patients are all HIPAA-compliant. This means they meet the stringent requirements set forth by the Health Insurance Portability and Accountability Act (HIPAA) to protect the privacy and security of your health information. Whether through SMS, email, or other forms of electronic communication, your information is handled with the utmost care and in full compliance with HIPAA standards.
By opting in to receive SMS communications from Dove Psychiatry, PLLC, you consent to the use of your phone number for appointment reminders, medication updates, and other relevant clinical communications. We are committed to ensuring these communications are secure and your information remains confidential.
If you have any questions or concerns about our privacy policy or the security of your information, please do not hesitate to contact our office.