Practice Policies

1. Services and scope of care

Form Psychiatry PLLC provides outpatient psychiatric services, which may include psychiatric evaluation, diagnostic assessment, medication management, and psychotherapy or supportive therapy when clinically appropriate and offered by your clinician. We may also coordinate care with other treating professionals with your permission. We do not provide 24/7 crisis or emergency services. If you are experiencing a psychiatric emergency or are in immediate danger, call 911, go to the nearest emergency department, or call/text 988 (Suicide & Crisis Lifeline).

2. Appointments, cancellations, late arrivals, and no-shows

Appointments are scheduled in advance and reserved specifically for you. Please help us use appointment time responsibly so we can offer availability to all patients.

2.1 Cancellation and rescheduling policy. You may cancel or reschedule without a fee when we receive notice at least 24 hours before your scheduled start time. If you cancel or reschedule with less than 24 hours' notice before your scheduled start time, a $200 late cancellation fee applies. If you do not attend your appointment (no-show), a $200 fee applies. Late cancellation/no-show fees are not billable to insurance and are your responsibility.

2.2 How to cancel or reschedule. Use the patient portal (preferred) or contact our office using the scheduling contact information provided to you. If you leave a voicemail/email/portal message, the time stamp of your message is used to determine whether notice was provided within the required window. If you are unsure whether we received your message, please follow up.

2.3 Late arrival. Please join your appointment on time. If you arrive late, your appointment may be shortened to end at the originally scheduled time. If you are more than 10-15 minutes late, we may need to reschedule the visit and it may be treated as a late cancellation/no-show depending on clinician availability.

2.4 Telehealth technical issues. If a technology issue prevents completion of the visit, we will make a good-faith effort to troubleshoot or transition to an alternate approved method (for example, telephone) when clinically appropriate and legally permitted. If we cannot connect after reasonable attempts, the appointment may be considered a late cancellation/no-show.

2.5 Appointment reminders. We may offer automated email/text reminders for appointments if you opt in. You are responsible for tracking your appointments; reminder failure (for example, spam filters or phone settings) does not waive the cancellation policy.

3. Telehealth policies

Many or all appointments may be provided via telehealth. Telehealth uses secure audio/video technology to deliver care when you and your clinician are in different locations.

3.1 Location and licensure. You must be physically located in a state/jurisdiction where your treating clinician is licensed (and where telehealth is permitted) at the time of your appointment. At the start of each telehealth visit, we may ask you to confirm your physical location and a callback number for safety purposes. If you are out of state or we cannot confirm your location, we may not be able to provide care and the visit may need to be rescheduled.

3.2 Privacy, environment, and safety. Join from a private, quiet location where you can speak freely. Use headphones if needed. Do not attend visits while driving or operating machinery. If you are driving, the clinician may end the visit for safety reasons. Do not record visits without explicit written consent from all parties, as required by applicable law.

3.3 Technology requirements. A stable internet connection, a device with camera/microphone, and a private space are strongly recommended. Keep your phone available as a backup in case the video connection fails. If others will be present (for example, family members), please tell your clinician at the beginning of the visit and obtain agreement on roles and privacy.

3.4 Telehealth risks and limitations. Telehealth has benefits (convenience, access, continuity of care) and limitations (technology failures, reduced ability to observe certain nonverbal cues, and potential privacy risks). You may withdraw consent for telehealth at any time; however, doing so may affect scheduling options and access to care.

4. Communication between visits

We aim to respond to routine messages within 1-2 business days. Messages received on evenings, weekends, or holidays are handled on the next business day.

4.1 Appropriate uses of messaging. Scheduling changes and logistics (preferred via patient portal). Medication refill requests (see Medication Policies below). Brief clinical updates that help us determine whether you need an earlier appointment.

4.2 Not appropriate for messaging. Emergencies or urgent safety concerns (use 911, go to the ER, or call/text 988). Lengthy clinical discussions, new symptoms requiring assessment, or medication changes that require an appointment. Threatening, abusive, or harassing messages (see Conduct section).

4.3 Phone calls and voicemail. If you leave a voicemail, please include your full name, date of birth, a callback number, and a brief reason for the call. We may return calls during business hours. Some issues require a scheduled appointment rather than a phone call.

4.4 Email and text messaging. Email and text messages are less secure than the patient portal. If you choose to use email or text, you accept the privacy risks. We do not use text or email for emergency communication or for detailed clinical care.

5. Medication management policies

Medication decisions are individualized and based on a thorough assessment, medical history, and ongoing monitoring. We cannot guarantee that any specific medication will be prescribed.

5.1 Refills and pharmacy coordination. Request routine refills several business days before you run out of medication. Refill requests should be submitted through the patient portal whenever possible and should include the medication name, dose, pharmacy, and whether the prescription is expiring or out of refills. Refills may require an appointment, updated clinical information, or completion of recommended monitoring (for example, vitals or labs). Prior authorizations and insurance-related delays are common; our team will assist when appropriate, but we cannot guarantee approval or turnaround time.

5.2 Controlled substances and safety monitoring. If your treatment involves controlled substances (for example, stimulants or certain sedatives), additional safeguards may apply to protect your safety and comply with federal and state regulations. These safeguards may include more frequent follow-up, review of prescription monitoring databases as permitted/required by law, urine drug screening, pill counts, and limits on early refills. No early refills for controlled substances except when medically necessary and approved by your prescriber. Lost or stolen controlled substance prescriptions are generally not replaced. Use one pharmacy whenever possible. Notify us promptly if your pharmacy is out of stock so we can discuss safe alternatives.

5.3 Medication changes outside visits. Medication changes typically require a scheduled appointment. If you experience significant side effects, contact us promptly through the portal and seek urgent care/ER services when appropriate.

5.4 Substance use and safety. Please tell your clinician about alcohol, cannabis, and other substance use. Substance use can affect diagnosis, safety, and medication decisions. If higher-level substance use treatment is needed, we may recommend referral to specialized care.

6. Care coordination, outside records, labs, and monitoring

We may request permission to communicate with your primary care clinician and/or other treating clinicians to coordinate safe care. You are responsible for providing accurate medication lists and relevant medical history. Depending on your treatment plan, your clinician may recommend periodic vitals, lab work, EKGs, or other monitoring. We may pause or adjust prescribing if essential monitoring is not completed.

7. Administrative requests, letters, and forms

Administrative paperwork takes clinician time and is separate from clinical visits. These services are typically not covered by insurance. Fees are charged per form/request and are due before the completed document is released. Fees per request:

Turnaround time is typically 7 business days after we receive (1) your request, (2) all required supporting information, and (3) payment; complex requests may take longer. Your clinician may require an appointment before completing forms, especially if the request involves disability status, work restrictions, or safety-sensitive duties. We cannot guarantee that any third party (employer, school, insurer, court, airline, housing provider, etc.) will accept or approve a form or letter. If a third party requires significant revisions or repeated submissions, additional fees may apply.

8. Financial and billing policies

A separate financial agreement may apply. In general: Payment (including copays/co-insurance/deductibles) is due at the time of service unless other arrangements are made in advance. You may be asked to keep a credit/debit card on file for convenience and to process applicable balances, including late cancellation fees. If a payment method is declined, you agree to provide an updated payment method promptly.

8.1 Good Faith Estimate for self-pay patients. If you are uninsured or self-pay, you have the right to receive a Good Faith Estimate of expected charges for scheduled services, as required by federal law. You may request a Good Faith Estimate at any time.

9. Confidentiality and privacy

Your privacy is important. We follow applicable privacy laws, including HIPAA when it applies, and we provide a Notice of Privacy Practices that describes how your health information may be used and disclosed and your rights regarding your information.

9.1 Limits of confidentiality. Confidentiality may be broken when required or permitted by law, including but not limited to: if there is a serious risk of harm to you or another person; suspected abuse or neglect of a child, elder, or dependent adult; certain court orders or legal requirements; and for treatment, payment, and health care operations as permitted by law.

9.2 Group practice and internal communications. Within our group practice, clinicians and staff may access necessary information to support treatment, scheduling, billing, quality improvement, and coverage. We limit access to the minimum necessary for job responsibilities.

10. Age requirements and legal decision-makers

Form Psychiatry PLLC provides outpatient psychiatric services to adults age 18 and older only. We do not provide services to minors. If you have a court-appointed guardian, conservator, or other legal decision-maker, we may request documentation describing decision-making authority. When required by law, we may need consent and/or participation from a legal decision-maker to provide services.

11. Professional boundaries and social media

To protect your confidentiality and avoid dual relationships, we do not accept friend/follow/contact requests from current or former patients on social media (Facebook, Instagram, LinkedIn, etc.). We do not provide clinical care through social media messaging. If we see each other in public, we will not approach you first in order to protect your privacy. You may say hello if you wish.

12. Respectful conduct

We are committed to providing a safe environment for patients and staff. Harassment, discrimination, threats, or abusive behavior (including through messages) may result in termination of services.

13. Discontinuation and termination of care

Either you or the practice may decide to end treatment. When possible, we encourage a planned termination process to support continuity of care. We may discontinue services after appropriate notice for reasons including (but not limited to): repeated late cancellations/no-shows or patterns of missed appointments; non-payment or unresolved balances; failure to follow treatment recommendations that are essential for safety (for example, required monitoring); treatment needs that are outside the scope of what we can safely provide (for example, need for a higher level of care); abusive or threatening behavior toward staff or clinicians; relocation to a state/jurisdiction where your clinician is not licensed. When clinically appropriate, we will provide referrals and may provide limited transition support. In some cases, we may provide a short-term bridge prescription at the clinician's discretion to support a safe transition.

14. Records requests

You may request copies of your records by submitting a written request through the patient portal or office process. Release of records to third parties generally requires your written authorization, except as permitted/required by law. Records are provided within the timeframes required by applicable law. Fees may apply as allowed by law.

15. Policy updates

We may update these policies from time to time. When updates are made, we will provide notice via the patient portal, email, or other reasonable methods. Continuing to receive services after notice of updated policies constitutes acceptance of the updated policies.

Effective: 2026-07-04