Since this may be your first visit to our site, we understand that you may have some questions about what to expect as you seek therapy and treatment. We hope that the following information about our professional services and business policies can help answer those questions.
New Client Information: under this tab you will find several sub-tabs that contain important information that you will need to read prior to your initial appointment. The 'Read only' sections contain a 'signature page' at the end. You do not need to bring these signature pages with you to your first appointment as these signature pages will be ready for you to sign when you check-in with the receptionist. Our receptionist will also give you Confidential Care's Financial Agreement to initial and sign and the Pre-authorized Credit Card Payment Form to complete.
**TriWest/Veteran's Choice clients do not need to sign the Financial Agreement or complete the Pre-authorized Credit Card Payment Form.**
IF YOU SHOW FOR YOUR APPOINTMENT BUT THE FOLLOWING PAPERWORK ISN'T COMPLETED, YOU WILL NOT BE SEEN. You must complete the following paperwork ahead of time and be prepared to turn it into the receptionist the day of your appointment. We will no longer delay the start time of the initial appointment while required paperwork is completed out in the lobby by the new client.
REQUIRED PAPERWORK TO BE COMPLETE
# 2. Address/Insurance Info.
# 3. New Client Questionnaire
# 4. Medical/Surgical History (only if seeing the nurse practitioner for the first time)
Please be sure to arrive a half-hour early prior to your scheduled appointment time so that our support staff can help you complete the intake paperwork and answer any questions that you may have regarding the intake process. If you are not sure where we are located please call ahead of time and we will do our best to provide you clear directions. Your appointment will start promptly at the scheduled time.
***Due to many people scheduling an intake appointment and failing to show or cancelling less than 24 hours our office has decided to enact the following: You have the option of securing the appointment time with your credit card. Your credit card will not be charged the 200.00 no show fee for the medication provider or the 100.00 no show fee for the therapist if you show for your appointment or give a greater than 24 hour notice of cancellation. If you choose not to provide your credit card to secure your intake appointment AND FAIL TO SHOW FOR THIS APPOINTMENT OR CANCEL LESS THAN 24 HOURS -- YOU WILL NOT BE RESCHEDULED. YOU WILL NEED TO FIND SERVICES ELSEWHERE OUT IN THE COMMUNITY. (TriWest/Choice Patients are exempt from having to secure their appointment with a credit card however, if they fail to show or give a less than a 24 hour notice of cancellation, they will not be rescheduled and TriWest will be notified that scheduling of future visits will be denied).***
1. Outpatient Service Agreement - Read only
Under this section you will find Confidential Care's Outpatient Service Agreement. It is important that you read over this document as it contains
important information about our professional services and business policies.
2. Address/Insurance Info. - Read, complete form, and bring it to your 1st appointment
Under this section you will find a request from us to obtain personal data and health insurance information from you. Please be sure to bring your
insurance card, a photo ID, and this completed form to your initial appointment.
3. New Client Questionnaire -complete form (required) & bring it to your 1st appointment
Under this section you will find the New Client Questionnaire form. It is most important that you complete this questionnaire to the best of your ability. You will not be seen for your initial appointment unless this questionnaire is available to your therapist/medication provider for their review. So please don't forget.
4. Medical/Surgical History - required form for nurse practitioner
VIEW THIS SECTION ONLY IF YOU ARE SCHEDULED TO BE SEEN BY THE NURSE PRACTITIONER FOR THE FIRST TIME. Bring the completed form to your initial appointment with Kristina Kruchowski, ANP. You do not need to complete this section if you are being seen by a therapist only.
5. Financial Policy and Agreement - Read only
Under this section you will find information relevant to financial matters to include insurance, non-billable fees, monthly billing statements, how to make a payment, refunds, self-pay, payment plan, and collection of unpaid debt. Attached to the Financial Policy is the Financial Agreement. Please read over the terms of the Financial Agreement carefully. Should you have any questions or need clarification on anything that you do not understand in this agreement, please don't hesitate to ask us. TriWest/Veteran's Choice clients are exempt and do not need to sign this agreement.
6. Pre-Authorized Credit Card Payment Form - Read only
Under this section you will find our policy regarding the securing of payment owed to Confidential Care for any unpaid balance that is due from the client. A pre-authorized credit card payment form along with 2 payment options that are available is explained further in this section. We assure you that your information is respected with the highest level of confidentiality, is not shared with any other source, and is securely protected separately from your therapy file. TriWest/Veteran's Choice clients are exempt and do not need to complete this form.
7. Notice of Privacy Practices/HIPAA - Read only
Under this section you will find information on the Notice of Privacy Practices/HIPAA. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. This section also contains information on your rights as a patient. Please review it carefully.
8. Administrative Discharge Policy - Read only
Under this section you will find our Administrative Discharge policy. This policy lists some of the circumstances that merit the termination of the
provider - client therapeutic relationship and the client being discharged from all services at Confidential Care.
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