Office Policies & Treatment Agreement
Welcome to Ellestad Psychiatry. Please review the following policies carefully. These policies are intended to clarify expectations and support a professional and collaborative treatment relationship.
Confidentiality
All treatment is confidential and protected under applicable federal and state privacy laws, including HIPAA. Information will not be disclosed without your written authorization except when required by law, including situations involving:
Risk of harm to yourself or others
Suspected abuse or neglect of a child, elder, or vulnerable adult
Court order or other legal requirement
When clinically appropriate, and with your consent, I may coordinate care with other healthcare providers.
Establishment of Care
The initial appointment is a comprehensive psychiatric evaluation lasting either 90 or 120 minutes. Completion of intake paperwork through the patient portal at least 48 hours prior to the appointment is required.
The initial evaluation does not automatically establish an ongoing physician–patient relationship or guarantee treatment. After evaluation, recommendations will be discussed, and treatment will begin only upon mutual agreement.
If your needs require a different level or type of care, appropriate referrals will be provided when possible.
Follow-Up Care
Regular follow-up appointments are required to ensure safe and effective treatment.
Follow-up visits are typically scheduled for 25 or 50 minutes depending on clinical complexity. Appointment frequency varies based on individual needs.
If you miss an appointment and do not reschedule within 90 days, your case may be administratively closed.
Patient Portal & Communication
This practice uses a secure electronic medical record system for scheduling, billing, prescriptions, and communication.
Secure messaging through the patient portal is the preferred method of communication for non-urgent matters.
Messages are typically returned within 24–48 business hours. Messages are not monitored continuously and should not be used for urgent or emergency concerns.
Emergency Policy
This practice does not provide emergency, after-hours, or weekend coverage.
If you are experiencing a psychiatric emergency, call 911, contact 988 (Suicide & Crisis Lifeline), or go to the nearest emergency department.
Do not wait for a response from this office in an emergency.
Medication Management
Medication decisions are made based on clinical evaluation and ongoing assessment.
Refills are typically provided during scheduled appointments. Requests outside of appointments require advance notice and may require scheduling.
A minimum of quarterly follow-up is required for ongoing prescription management.
Prescription monitoring databases may be reviewed as part of safe prescribing practices.
Controlled Substances
Controlled substances may be prescribed when clinically appropriate and in accordance with federal and state regulations.
Patients agree to:
Take medications only as prescribed
Not obtain controlled substances from other providers without disclosure
Safely store medications
Comply with monitoring requirements, which may include periodic toxicology screening
Early refills for lost, stolen, or overused medication are not guaranteed.
This practice does not prescribe opioid pain medications however I do prescribe suboxone for opiate use disorder.
Cancellation Policy
Appointments require at least 48 business hours’ notice for cancellation or rescheduling.
Late cancellations and missed appointments are billed at the full appointment rate.
Telehealth appointments require that you are physically located in a state where I am licensed at the time of service.
Billing & Payment
Payment is due at the time of service and is charged to the card on file.
Current self-pay fees:
Initial Evaluation (90 minutes): $645
Initial Evaluation (120 minutes): $845
Follow-Up (50 minutes): $420
Follow-Up (50 minutes psychotherapy track): $395 (minimum biweekly scheduling)
Follow-Up (25 minutes): $295
Follow-Up after absence > 6 months (50 minutes): $520
Fees are subject to periodic adjustment with advance notice.
Superbills may be provided for potential out-of-network reimbursement. Insurance reimbursement is not guaranteed.
Between-Appointment Services
Administrative or clinical services provided outside scheduled appointments (e.g., extensive forms, record preparation, extended phone calls, or clinical messaging) may be billed based on time required.
Laboratory Services
Laboratory testing may be ordered when clinically indicated. Standard laboratory services are typically billed directly by the laboratory to your insurance.
Specialized testing, when requested or clinically appropriate, may involve additional fees, which will be discussed in advance.
Limits of Service
This practice provides outpatient psychiatric evaluation and treatment.
The following services are not provided:
Forensic evaluations or court testimony
Disability or worker’s compensation evaluations
Court-ordered treatment
Transcranial Magnetic Stimulation (TMS)
Electroconvulsive Therapy (ECT)
Opioid pain management
Referrals can be provided when appropriate.
Termination of Care
You may discontinue treatment at any time.
The practice reserves the right to terminate treatment when clinically appropriate, including but not limited to:
Non-payment
Repeated missed appointments
Unsafe medication use
Failure to follow agreed-upon treatment parameters
Behavior that compromises safety or professional boundaries
Need for a higher level of care
Reasonable efforts will be made to provide referral options when possible.