Forms
These forms can be filled out, signed, and submitted online. Please contact our front office if you have any trouble accessing and submitting the forms.
Fresh Start for the Mind accepts certain insurance plans. Private-pay rates are as follows:
- Psychological Testing: $200 for intake; $90 per testing codes (96136/7/8/9) and $180 per testing codes:
(96130/1) – amount of codes required is determined after intake; and $180 for feedback session
- Counseling: $150 with doctor-level clinician; $125 with LPC; and $90 with APC
- Coaching & Dietitian: $150 for intake; $90 for follow-up appointments
Any additional service, such as phone consultations, excessive paperwork or letters, prescription refills, court appearances/preparation, and retrieving files older than six (6) months will incur additional fees to be discussed prior to the service provided. Sliding scales are negotiated between clinician and client, and will be occasionally revisited as personal needs and/or professional statuses change.
You are responsible for understanding your insurance and contacting your insurance carrier when requested. The collection of benefits or any other arrangement regarding third party payment is the responsibility of the client or legal guardian. You are responsible for notifying Fresh Start for the Mind of any change in your insurance prior to your next scheduled appointment. Otherwise, you will be required to pay in full for your visit immediately upon discovery.
Late Cancellation / No Show Policy
We understand that sometimes it may be necessary to cancel or reschedule an appointment at the last minute due to medical problems or significant conflicts which cannot be avoided. These cancellations, however, can results in unused session or testing time in which other patients could benefit.
Please Note, You are expected to attend all scheduled sessions. This includes new, intake appointments. Fresh Start for the Mind, LLC employs the following Late Cancellation / No Show policies for these services:
Psychiatry
- If you need to cancel your appointment, you are required to call NO LATER THAN 24-BUSINESS-HOURS PRIOR to your scheduled appointment (Saturdays and Sundays are NOT considered business days). You will be charged the full session fee (i.e., pre-determined self-pay amount or amount billed to insurance company for service) for appointments cancelled with less than 24-business-hours notice.
Psychological Testing / Evaluation
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Late cancellations or no shows often result in unused testing time in which other patients could have benefitted. Additionally, this creates a loss of valuable, productive time by our psychologists and/or psychometrists. The process for psychological testing / evaluations includes preparation of staff and materials, and it blocks a substantial amount of scheduling time. Your insurance authorization may be affected as well. There is typically a time frame that insurance companies allow to have services done and if it is rescheduled, we cannot always guarantee that they will extend that time frame. If you need to cancel your appointment, you are required to call NO LATER THAN 48-BUSINESS-HOURS PRIOR to your scheduled appointment (Saturdays and Sundays are NOT considered business days). You will be charged $90 for appointments cancelled with less than a 48-business-hour’s notice. In order for us to maintain efficiency, as well as give full consideration to our patients and providers, it is necessary for us to implement this cancellation policy and the only consideration of waiving the $90 fee will be with the submission of a doctor’s note within 24-hours of the scheduled appointment.
Counseling & Coaching
- If you need to cancel your appointment, you are required to call NO LATER THAN 24-BUSINESS-HOURS PRIOR to your scheduled appointment (Saturdays and Sundays are NOT considered business days). You will be charged half the provider’s self-pay rate, up to $75) for appointments cancelled with less than 24-business-hours notice.
Fresh Start for the Mind reserves the right to refuse future services beyond multiple missed appointments or late cancellations.
Appointments
To schedule an appointment today, contact us at (404) 808-1161 or complete our online appointment request form.