WELCOME TO AUSTIN PSYCHCARE!
Thank you for choosing our practice! Deciding to engage in psychiatric treatment can be a difficult process, and we’re pleased at the opportunity to work with you. Though it may seem like a lot of information, please read this document carefully as it contains important information about professional services, business policies, and the respective rights and responsibilities of both provider and client. By signing this binding agreement, you are providing informed consent to engage in a treatment relationship. Please feel free to ask questions about the information below before you sign.
SERVICES AND INITIAL CONSULTATION
We are board certified in the state of Texas to practice psychiatry, which includes prescribing medications, providing psychotherapy, or both, depending upon your particular treatment needs. During your initial visit, your provider will take a detailed history and make treatment recommendations based on the session, along with impressions of what our work together may entail. Please note that initial consultations are designed to help determine if the client and provider are a good fit for continued treatment. Successful treatment requires an active and committed approach by both clinician and patient, so it’s important for you to consider whether you’re comfortable working with your provider. Additionally, we don’t prescribe controlled substances such as benzodiazepines (Xanax, Klonopin) or stimulants (Adderall, Ritalin) at the first visit. If you have questions regarding your provider’s professional training or clinical procedures, please bring them up in your visit.
CLIENT-PROVIDER COMMUNICATION
A productive treatment relationship is based on open communication. If you have questions or concerns about your treatment, please call 512-454-7741. Do not use our website or email as a means of communication. Please note that our providers do not take phone calls during appointments barring emergencies. During office hours, you may leave a non-confidential voicemail or message with staff. Urgent calls are returned as soon as possible non-urgent calls are addressed within 24-48 hours, depending upon the nature of the message. To ensure that we can reach you in a timely manner, please ensure that your contact information is accurate and up-to-date.
CONFIDENTIALITY
Trust and safety are paramount in the treatment of your mental health. We and all staff members take confidentiality very seriously. Federal law prohibits the release of any information about our work without your written permission, with a few exceptions:
1. If your provider believes you could harm yourself or others.
2. If your provider suspects child or elder abuse.
3. If a court subpoenas your records
4. If an on-call physician from this office needs information to treat you appropriately in your provider’s absence
INSURANCE
Dr. Michelle Magid, MD is currently not accepting insurance. Isadora Fox, PMHNP, APRN-BC is paneled on Seton Health Insurance and Blue Cross Blue Shield PPO. Clinicians can provide paperwork for clients on other plans who choose to file out of network.
*We understand that insurance can be confusing, which is why we verify your coverage when you schedule your appointment. If there is still confusion about your insurance at the time of your visit, you may attend your appointment and pay the full fee, copay, or deductible identified through our benefits agent. If there is discrepancy discovered after we file the claim, we will collect the remaining balance or issue you a refund. Alternatively, you may reschedule and clarify coverage with your insurance company.
PAYMENT
Payment is due in full before each session, and clients are required to keep a current credit card on file. We accept cash, checks, MasterCard, and Visa. There is a $25 charge for returned checks. Fees Our fee schedule is listed below, including rates for professional services outside appointment time. Paperwork such as school or insurance forms must be completed during a scheduled session with the expectation that the client has filled out his or her portions before the visit. Our practice reserves the right to evaluate whether we are the appropriate clinical resource for these requests and refer accordingly.
MD - Type of Visit, Duration of visit, cost
Initial Evaluation 60 minutes $400
Follow-up, medication management 20 minutes $175
Follow-up, therapy/medication management 45 minutes $250
Other professional services (report writing consultations, phone calls 5+ minutes), $300 per hour
PMHNP - Type of Visit, Duration of visit, cost
Initial Evaluation 60 minutes $300
Follow-up, medication management 20 minutes $140
Follow-up, therapy/medication management 45 minutes $200
Other professional services (report writing consultations, phone calls 5+ minutes), $240 per hour
APPOINTMENTS AND CANCELLATIONS
Treatment is available by appointment only. Cancellations must be made 48 hours in advance (Thursday for a Monday appointment) by calling the office. Missing an appointment and/or failing to cancel within 48 hours of appointment time will result in the full charge for the missed appointment. If this occurs, we will automatically charge your on-file credit card. Patients covered by insurance must pay the full cash fee for missed appointments—not just the copay/deductible fee. Repeated no-shows or late cancellations may lead to discontinuation of treatment.
PRESCRIPTIONS AND PRESCRIPTION REFILLS
In the interest of safety, clients who take medications must be monitored by their provider to assess effectiveness and side effects. You will receive ample medication and refills until your next appointment. It is your responsibility to schedule follow-up appointments before your prescription runs out. Please note that we are conscientious about medical costs and do not request unnecessary visits. Medications refilled between visits typically provide the client with enough to make it to his or her next appointment. Refills for triplicate medication (stimulants for attention deficit disorder) between appointments are completed for a $20.00 fee. We take great care to prescribe safely and effectively. In return, clients are expected to take medications as prescribed. Altering a medication’s dose without a provider’s consult, sharing medication with others, or using them in a non-therapeutic way is a serious breach of the provider-patient trust and may result in termination of the treatment relationship.
EMERGENCIES
During business hours, please contact our office at (512) 454-7741. Our staff can get in touch with your provider or an on-call physician to address your needs. After business hours, please contact our 24-hour answering service at (512) 404-9076. In the case of extreme emergency, call 911, or seek immediate care at your nearest emergency department.
DISCONTINUING TREATMENT
Clients may discontinue treatment at any time, but we ask that you consult with your provider before making this decision. In therapy, experiencing uncomfortable feelings is a key part of personal growth and progress talking to your provider may help you clear this hurdle and may even help us become better practitioners. We will assume you have discontinued treatment if you’ve missed a scheduled appointment and do not reschedule within 30 days, you fail to schedule a follow-up appointment within 6 months of your last appointment, or you have not been seen in a year. Upon written request, our office will transfer records to an alternate provider. In rare instances, after careful consideration, your provider may discontinue your relationship. This may occur if there are repeated missed appointments, medications are not taken as directed, an unexpected conflict of interest arises, or your provider believes your needs would be better served by another clinician. If this occurs, you will be notified in writing.
OFFICE SPACE
Austin PsychCare is an independent practice housed in a shared office space with other independent psychiatrists, nurse practitioners, and therapists at 1600 West 38th Street Suite 404. We are all separately licensed and are responsible for our independent practices.
Again, we appreciate the opportunity to be of service to you. If you have any questions, concerns, or suggestions regarding this practice, please discuss them with your provider. We are always eager to hear your comments and will gladly answer any questions. Your signature below indicates that you have read the above and consent to the terms of this contract.
• I have read and understand the office policies regarding financial arrangements, fees, and charges for missed
appointments or late cancellations. I voluntarily consent to treatment and understand that informed consent ends
with the termination of the professional relationship. I may terminate this relationship at any time.
• I have also received the Notice of Privacy Practices and I have been provided an opportunity to review it.
