New Patient WITHOUT Appointment Start Here:

ALREADY SCHEDULED Appointment Continue Here:

 Online Consent Form 

Complete Your Past Psychiatric And Medical History Here:

Click Here to download PDF version of forms (excluding Past History):

OUR CLINIC IS NOT A CRISIS CENTER AND DOES NOT MANAGE ACUTE CRISIS

IN CASE OF EMERGENCY

• If experiencing a life-threatening EMERGENCY, please dial 9-1-1

• Central Arizona Crisis Line: (602) 222-9444 or (800) 631-1314

• National Suicide Prevention Lifeline: (800) 273-8255 (TALK)

• Teen Lifeline (www.teenlifeline.org): (602) 248-8336 (TEEN)

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CLINIC POLICY

• We DO NOT provide primary substance abuse treatment. Since our providers are not substance abuse or addiction specialists, we recommend person go to an agency who specializes is substance abuse/addiction treatment or detox for more customized care.

• For medication management, we DO NOT accept patients who are LESS THAN 30-days removed from substance abuse rehab (6-months for very addictive drugs).

• For medication management service, we DO NOT accept patients who are actively receiving Medication-Assisted Treatment (MAT) for substance abuse.

• We DO NOT have a contract with Workers Comp agencies, hence patient will be financially responsible for all cost.

• We DO NOT have a contract with MEDICARE, hence patient will be financially responsible for all cost.

• We DO NOT have a contract with AHCCCS, hence patient will be financially responsible for all cost.

• For medication management services, we DO NOT accept MEDICARE (Supplement Plan) or AHCCCS patients.

• For therapy services, AHCCCS patients can be seen if (1) self-pay, or (2) has active single-case agreement.

• Prior to completing any DISABILITY PAPERWORK, patient must understand the following:

  • Person must have AT LEAST three (3) appointments with the SAME provider for three (3) months.

  • Clinic DO NOT complete long-term disability paperwork.

  • Clinic DO NOT complete SMI paperwork.

• For MEDICAL RECORDS REQUESTS, the following applies:

  • Anticipate at least SEVEN (7) BUSINESS DAYS to process.

  • Release of Information (ROI) must be in place at time of request.

  • There is NO COST to process and send medical records to another provider or clinic to coordinate clinical care.

  • There is a FEE to process, collect, and send medical and billing records to a non-clinical agency or entity or person.

• Our providers DO NOT participate in court cases, custody cases, nor workman comp cases. If provider must be subpoenaed, then patient is financially responsible for ALL legal-specific cost incurred.

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NO SHOW/LATE CANCELLATION POLICY

• We impose an automatic No Shows/Late Cancellations FEE of $150 for INTAKES and $100 for FOLLOW-UP.

• Fees are due by invoice or on next scheduled appointment.

• LATE CANCELLATION is described as:

  • Cancellation under 24-hours prior to scheduled appointment​ (Monday appts must be cancelled by Friday 12pm). Cancellation must be confirmed by staff to be valid.

  • 15-minutes LATE to an INTAKE (patient portal must be completed by time of scheduled appointment)

  • 8-minutes LATE to a PSYCHIATRIC (MEDICATION) FOLLOW-UP

  • 15-minutes LATE to a THERAPY FOLLOW-UP

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MEDICATION REFILL POLICY

• All medication refill requests or questions must be emailed to REFILL@LHPSYCH.COM.

• Medication refill request takes SEVEN (7) BUSINESS DAYS to process.

• We DO NOT accept medication refill request by phone.

• We DO NOT check emails on the weekends. Hence, refill requests received on the weekend will be reviewed on next available business day.

• NO SAME DAY REFILLS, without exception.