Psychiatrist-Patient Agreement

By signing this agreement, I acknowledge that I have read and understand the following:

Our goal is to provide a high level of psychiatric care in order to have the best results for our patients. The following policies and procedures are intended both to ensure the best care we can by being clear about patient requirements, as well as to ensure that we can operate our practice smoothly.

1. Clear and timely communication is essential for proper clinical care. Please notify us without delay by telephone with any questions or problems regarding your treatment. Please contact us prior to making any treatment changes (e.g. change in medication dose, stopping medications, adding additional psychotropic medications) or with any urgent matters. Please don’t hesitate to contact the office if you have concerns about potential side effects.
2. Patients are expected to follow-up a timely manner with evaluations necessary for their care e.g. laboratory testing, psychological testing, medical evaluations, specialist referrals, and so on.
3. Emergencies: Call 911 or go to the nearest emergency room for medical emergencies, and have the doctor contacted after you arrive.
4. Please use the office telephone for any routine matters. Urgent contact information (pager or mobile number) is provided on the office voicemail. An urgent situation is one in which you are unsure whether you are experiencing a clinical emergency and want to check to see if you should seek emergency services. If you are unsure whether you are experiencing an emergency, and cannot reach the doctor, please seek immediate medical attention.
5. We do not use text messages in our practice. If you would like to use email, please discuss with us how to use the encrypted email service with which we work. We only use email for administrative purposes, and not clinical concerns. We may not receive important messages in a timely manner using email.
6. If you discontinue treatment, the doctor will provide coverage for 30 days from the date of termination in order for you to transition your care, including prescriptions to cover 30 days from the date of termination, and assistance with referrals. Please notify us if you plan to stop treatment or seek treatment elsewhere. If you stop treatment and have passed the coverage period, we will not be able to provide clinical care including prescriptions. At the doctor’s discretion, we may agree to re-consult and potentially resume a treatment relationship.
7. Our policy if patients do not make schedule appointments is to attempt to reach patients twice by telephone or HIPAA-compliant email, and then send one ground mail outreach letter, followed by a termination letter with recommendations and referral possibilities if we are unable to make contact. The treatment relationship is determined to have ended either when patients notify us they have stopped treatment, or we otherwise learn or conclude they have stopped treatment (e.g. no response to outreach efforts, another provider informs us she or he has taken over care, etc.).
8. If you are a patient scheduled less than once per week, we require 72 hour notice to reschedule your appointment. If you are scheduled once a week or more frequently, we require 48 hour notice to reschedule your appointment. We reserve the right to charge for missed or cancelled appointments with less than the required notice, barring true medical or family medical emergencies. We charge for appointments missed or cancelled due to transportation issues, work-related scheduling changes, weather, etc. Dr. Patel may offer a telephone session in cases of weather or transportation issues.
9. Please arrive on time for your appointment. If you will be late, please call our office to notify us. Late patients will be seen only for the time that has been scheduled for them, at our discretion.
10. In order to assure adequate continuity of care. Dr. Patel meets with patients at minimum every three months, and more frequently as clinically indicated e.g. to provider closer monitoring, to check medication responses and make adjustments, to follow up on behavioral treatments and responses.
11. For patients who meet less than once per week, payment is at the time of your appointment. Payment may be in the form of checks, cash and credit/debit cards. For patients who meet regularly on a weekly or more frequent basis, we bill at the end of the month and request payment by the following week. Please let us know if you have any problems with payment, and we will make every effort to accommodate.
12. Prescriptions are provided electronically (except in the case of controlled substances which require a paper prescription in NYS) during appointments. Please keep track of whether you require refills so this can be done during scheduled appointments. If you find you are running low on medication, a refill may be requested with a minimum of 2 business day advance notice. An administrative fee of $25 will apply if regular (>3 times) requests are made with less than 2 business days advance notice. Please note that insurance will not cover this fee.
13. There is a $30.00 administrative fee for returned checks. Please note that insurance will not cover this fee.
14. Patients are expected to behave appropriate to a professional setting when in the office, and when communicating with doctors and staff. We reserve the right to discharge patients who are disruptive to the care environment, inappropriate or threatening to staff or other clients, or who otherwise create an unsafe or uncomfortable professional environment. We will make every effort to clinically address issues which may be contributing to such behaviors, as appropriate, prior to discharge.
15. If a patient is consistently unable to work within the agreed framework described above, we reserve the right to refer to intensive level of care (e.g. a hospital-based practice) and end the treatment relationship due to non-adherence. We will make every effort to remind and help patients to work within the treatment agreement before referring out.