INFORMATION ON PSYCHIATRIC TREATMENT
Welcome to Future Forward Behavioral Health, a private mental health practice designed to treat mental health disorders in the child and adolescent population. The outcome of any proposed treatment largely depends upon the collaborative relationship developed between you, your child and Anessa Holman. Mrs. Holman understands that discussing feelings and problems that impact your child's life can be difficult to discuss at times. With this said, for Anessa to give your child the proper attention and treatment, honest, open communication is needed. If ever during the treatment time together you or your child feel overwhelmed or discouraged, that is when it is most important to communicate those feelings to Mrs. Holman. Open communication from both parties will greatly increase the chance of your child meeting all their desired goals.
As your chosen mental health provider, you and your child have the right to expect courteous, professional, compassionate and knowledgeable care that reflects mutually agreed upon interventions and goals for success. You have the right to end this professional relationship at any time, for any reason, without moral, legal or financial obligation, except for those charges already incurred for services rendered.
We cannot render services on the assumption that the charges will be paid by an insurance company. All services are charged directly to the patient, and he or she remains personally responsible for payment. As a courtesy, however, we will process insurance claims to assist in making collections from insurance companies. Any money received from insurance companies will be credited toward the patient's account.
CO-PAYMENT & PAYMENTS WHICH ARE THE PATIENT'S RESPONSIBILITY ARE DUE AT THE TIME OF SERVICE
Future Forward Behavioral Health, LLC, does not get involved with the financial aspects of disputed cases with insurance companies, workers' compensation, motor vehicle accidents, liability cases or any other types of claims. Each patient (parents if minor) is ultimately responsible for the payment of their account. Accounts delinquent for greater than 180 days are subject to dismissal from Future Forward Behavioral Health, LLC
Keeping your scheduled appointment is essential for developing and maintaining rapport and for ongoing success with the proposed treatment plan. A 24-hour appointment cancellations notice is required to remain in good standing. The appointment times provided are often given weeks in advance. When you miss your appointment, the next available one may be weeks away. We understand that their are circumstances that are unavoidable and will result in a missed appointment When this happens, please be courteous and cancel no later 24 hours prior to the appointment. This allows us to place another client in your time slot. If after 3 consecutive missed appointments without a 24 hour notice of cancelation, Future Forward Behavioral Health LLC, reserves the right to dismiss you/your child from the practice. If this occurs, you will be provided notice and can be seen for 30 days on an emergency-only basis. Future Forward Behavioral Health LLC, reserves the right to charge $40.00 for missed appointments without the required 24 hour notice. This charge will be the guarantee's responsibility and must be paid in full prior to being seen for then next scheduled appointment.
Future Forward Behavioral Health LLC, or any of it's providers reserve the right to change this agreement at any time. Notice of such changes will be provided in writing.