INTEGRATED HEALTH & WELLNESS SERVICES, LLC

    1508 PENNSYLVANIA AVENUE
    WILMINGTON, DELAWARE 19806
    PHONE: 302-427-8000
    FAX: 833-989-2148

    Integrated Health & Wellness Services

    PATIENT TREATMET INFORMATION AND CONSENT

    INITIAL EVALUATIONS AND FOLLOWS UPS SESSIONS

    Initial evaluations are scheduled for 60 minutes visit. During this visit, comprehensive assessment is necessary to help us evaluate your symptoms, your past treatment history, attempted treatment options and benefits outcomes and the reason for seeking current visit. With individuals with past treatment history, Integrated Health and Wellness Services requires that you provide us with your past treatment records, tests and any recommendation that will be beneficial in continuing care and helping us in making treatment plans that will be beneficial for your treatment goal.
    In cases of an extensive psychiatric history or complicated presentations, extra time might be needed to gather and complete the information necessary to provide the best treatment for your mental health needs. You might be rescheduled for another time to allow time for completion of the evaluation.
    Medication when indicated might not be prescribed in situations involving incomplete evaluations, missing records, tests, or authorization. To ease the disruption in treatment and delays in continuation of care, we required that all records be provided prior to your initial visit. Recommendation from your providers either specialty providers might be necessary in order to continue initiate care with us. Prescription of some medications my require additional documentation or a psychological testing. If in case this is required, the prescriber will discuss this with the patient.
    Patients may request transfer to another provider or referred by another provider within the group. Please note that such transfer will be scheduled for an initial evaluation with the new provider. This is to allow adequate time for record evaluation and assessment to better give the new provided the opportunity to know the patient’s needs. 

    PSYCHOTHERAPY

    Engaging and participating in psychotherapy has benefits such as significant reduction in distressed situations, improved social relationships, resolution of specific conflicts, improvement in communications, self-understanding, insight, values, and goals. Although there are no guarantees about what will happen in therapy, open communication is encouraged for a successful treatment. For therapy to be most successful, you will have to be able to talk openly and frankly address any difficulties that arise and put forth active effort outside therapy sessions to work on goals. Psychotherapy may require unpleasant revelation of your past therefore, in the initial stages of treatment, psychotherapy may raise uncomfortable levels of anxiety, sadness, anger, guilt, frustration, helplessness and loneliness. This could impact your relationship with others including the therapist. The goal is to help the individual walk through this process. Please inform your therapist If you experience any discomfort as this will help to adjusting your treatment session to your own comfort level.
    Combination of psychotherapy and pharmacotherapy has shown effectiveness in management of symptoms. At Integrated Health and Wellness services, we require all our patients to be evaluated by the therapist. After the evaluation, the therapist wouldn't determine if ongoing therapy would be needed. If an ongoing therapy is needed, the therapist would determine the frequency and discuss this with the patient. Individuals receiving medication management that are determined to need psychotherapy must engage actively in psychotherapy in order to continue medication management. Patients receiving therapy at another practice will need to provide record of an ongoing session with their treating provider.

    MEDICATIONS

    At Integrated Health and Wellness Services, prescribers collaborate with the therapists to determine what treatment goal is beneficial for the patients. If medication is indicated, the prescriber will discuss with the patient what medicine would be used. The prescriber will discuss other reasonable alternative treatment options, medication treatment expected outcome, side effects of the medication, and instructions on how the medication will be taken. Ongoing follow ups will be discussed with the patient.
    Follow ups is personalized based on involvement of many factors including but not limited to the type of medication, duration of treatment and response to the medication. Some medications might require the provider to follow protocol set forth by the treatment guidelines or as regulated by the law. Medication monitoring that are dependent on lab monitoring or treatment requiring specific guidelines will be discussed with patient. Patient understands that adherence to the treatment expectation is required to continue medication management. At the end of the initial visit, the patient will have the opportunity to ask questions and address any concern that patient might have regarding treatment plan.

    OTHER PROFESSIONAL SERVICES

    In order to attend to your needs, all other professional services outside your routine services requiring provider’s time will be scheduled and charged similar to the fee of that provider’s professional services. These needed services might include but not limited to evaluating documents, returning calls, preparing documents, summaries of treatment notes, and school notes preparations. Please note that we do not participate in filing disability claim applications.

    PROFESSIONAL RECORDS

    Patients’ have the right to their records and can review their record. Because these are professional documents, they can be misinterpreted which can be upsetting to some individuals therefore, we recommend you review your records with your provider to guarantee understanding of any concern. This will provide an opportunity for a discussion of what they contain.
    Please note that you are responsible for the cost of obtaining and or sending your requested record. A signed consent is required of all record request. You will be charged $0.25/per page for all the records requested. You will be responsible for the cost incurred from mailing the record. These fees will be paid prior to release of record.

    CANCELLATIONS AND NO-SHOW POLICY

    You are expected to attend your visit once scheduled. If the visit is canceled less than 48 business hours in advance, you will be charged for the visit. Missed follow up visit will be charged at $50 while the initial visit will be charged the full cost of the visit. Business hours are considered the weekdays between Monday and Friday and between the hours of 8 a.m. and 5 p.m. This do not include evenings, weekends or holidays when the office is closed. We understand that time is important and attempts to maintain each patient’s visit as scheduled. Be sure to arrive for your visit at least 15 minutes prior to the visit. Arriving late for the visit might result in not being able to be seen for the visit.

    BILLING AND PAYMENTS

    Payment for the visit is due at the time service is provided. We accept credit cards, personal checks and cash. **Please note: there is a $30 administrative fee charged for any returned check and for any declined credit card payment. If your account payment becomes overdue for over 60 days, we have the option of using legal means to obtain payment, including collection agencies or small claims court. To avoid this from happening, we encourage that you to keep an active credit card on file to charge for your sessions.

    INSURANCE REIMBURSEMENT

    We make every effort to decrease the cost of your medical care. Therefore, we request payment arrangements for all office services at the time they are rendered unless prior arrangements have been made. We accept cash, checks and credit card payments. If we are a participating provider of your insurance company, we will bill them. However, payment is the patient's responsibility. We will help in any way we can to assist you in handling claims.

    CONTACTING US

    Our staff are available to assists you during normal business hours. Dial 911 in a case of emergency for immediate assistant or proceed to the nearest emergency room. For non-emergency calls, you can reach us at 302-427-8000. If our staff is busy when you call, our voice mail will receive your message. We monitor our voicemail frequently and will return your call within 24 hours except for calls received after business hours, holidays and weekends. For all calls please contact us at 302-427-8000 and leave us a message include the patient’s name, date of birth, best number to reach you and reason for your call.

    Name of patient (print):

    Date:

    Signature of patient: