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 copay once my appointment has been confirmed.*

I understand my appointment copay is NON-REFUNDABLE if I fail to attend my appointment without a 24-hour cancellation notice.*

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

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

I understand my appointment request will be DENIED if I fail to complete my new-patient paperwork / treatment consents / copay within 48 hours (excluding weekends and holidays).*

I understand Front Porch Psychiatry does not prescribe Suboxone / Methadone / Medical Marijuana and does not provide addiction treatment of any kind.*

I understand Front Porch Psychiatry does not prescribe benzodiazepines (i.e. Xanax, Ativan, Klonopin, etc.) for daily use.*

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