I understand this is a REQUEST for a new-patient appointment. A request does NOT guarantee an appointment, as not all patients will qualify to receive services or may require a higher level of care.*

I understand I am REQUIRED to pay my insurance copay / coinsurance fee at the time I schedule my appointment to secure my preferred date / time.*

I understand my initial insurance copay / coinsurance fee is NON-REFUNDABLE if I no-show my first appointment or fail to give a proper 24-hour cancellation notice.*

I understand I am REQUIRED to upload a copy of the front and back of my insurance card.*

I understand my appointment request will be CANCELLED if I fail to complete my New-Patient Paperwork & Treatment Consents within 72 hours (excluding weekends and holidays).*

I understand I am required to keep an active credit or debit card on file at all times.*

I understand that all new patients are required to attend their first appointment in-person.*

I understand that virtual appointments are not available for out-of-state residents and clients prescribed controlled substances. These clients must be seen in-person at every appointment.*

I understand there is a $75 NO-SHOW fee if I fail to cancel my appointment the day before. *

I understand that all requests for ADHD medication MUST undergo a formal evaluation for proper diagnosis. *