Information

Getting Started:

Start the process with our secure New Patient Information Form.
What to bring to your appointment:

  • Your insurance card
  • A list of current prescription or over-the-counter medications you are taking, including dose and frequency.
  • Pertinent information about your medical and surgical history.
  • Forms the office may have sent you (which can be downloaded directly below)

Forms:

Please click on a link below to download and print the appropriate form. Please complete and bring to your initial session.

 

get_adobe_readerNote: These forms are Adobe Acrobat documents.
Click on the button to download a free copy of Adobe Reader.

DGR Behavioral Health, LLC is committed to protecting the privacy of your health records. In providing behavioral health services, we create and maintain records regarding you and the treatment and services we provide to you. The law requires that we maintain the confidentiality of behavioral health information that identifies you. We handle this information only as  allowed by Federal/State Law and our Policy, adhering to the most stringent law that protects your behavioral health information. We are also required, under HIPAA, to provide a written “Notice of Privacy Practices.” This notice is provided at each intake.  By law, information regarding whether or not you are a consumer at DGR Behavioral Health, LLC or any details of your diagnosis or treatment may not be revealed to anyone outside the center without your written consent. There are some exceptions, such as suspected child abuse, medical emergencies, or a court order.

Cancellation Policy:

Therapy is a commitment and an agreement. When an appointment is scheduled, the time is set aside for you and no one else. The hour is not double-booked, and attendance to sessions is very important. Cancellations and missed appointments  not only interfere with your treatment progress, but also affect other clients who could have used that hour but were scheduled at a later date.

Consequently, it is appreciated that cancellations and/or missed appointments are avoided unless there is an emergency or an illness. Your clinician will make every effort to provide you the same courtesy.

If you must reschedule or cancel an appointment,  please provide advance notice (greater than 24 hours) so that the hour can be given to another client. This courtesy is appreciated and shows a commitment to your treatment as well as respect for the needs of other  clients and your clinician’s time.

An appointment cancelled on less than 24 hours notice, and missed appointments, will be billed a cancellation fee. This fee will not be charged to insurance, and is your responsibility to pay in full. Same-day cancellations due to weather conditions (snow  & ice) will not be charged as long as a telephone call is received in the office the morning of the appointment.

Prescription Refill Policy:

We strive to provide the best and most appropriate care. Recently, last minute requests for call in medication refills have increased significantly, resulting in a strain in staff time. Also, medications called in over the phone, particularly by a covering physician, are more prone to errors. For these reasons, we are instituting the following protocol, both to limit call-ins and to ensure that there is sufficient time to do them accurately.

  • If you wish to avoid a charge for call in prescriptions, you must make your request on Monday through Thursday, 9:30 a.m. to 4 p.m. or on Friday from 9:30 a.m. to 12 noon. Please allow up to 24 hours for your prescription to be called in.
  • If you request a call in prescription outside these hours, there will be a service charge of $20. This charge will not be covered by your insurance.
  • If a covering physician responds to your request, you can expect that you will have only a limited supply of medication called in. The service charge of $20 will still apply.
  • To avoid having to call in for prescriptions, please try to keep your regularly scheduled appointments, as our physicians try to write prescriptions in a way that ensures you will be covered from one visit to the next.

If you anticipate running out of medication in advance of your next scheduled appointment, please give yourself and us enough time by calling at least one week before you run out of medication.