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Important Notices:
1) Privacy Advisory: Please refrain from disclosing any protected health information on this form. Such details will be discussed during a confidential phone consultation or initial evaluation. By providing your phone number, you consent to receive SMS messages related to scheduling, care coordination, or follow-up. Message frequency may vary; standard message and data rates may apply. You may opt out at any time by replying “STOP.” All clients sign comprehensive consent forms prior to their first session that include details on privacy and communication practices.
2) Good Faith Estimate: I am committed to providing a “good faith estimate” of anticipated charges for services upon request. This estimate will be provided before any services are rendered, ensuring transparency in our billing process.
3) Insurance Participation: At Grace Psychiatric Services, PLLC, we have chosen to operate independently from insurance panels, Medicaid, and Medicare. This decision reflets our dedication to placing the needs and preferences of our clients first, ensuring a personalized and confidential therapeutic experience. A ‘superbill’ will be provided upon request, for potential reimbursement purposes.