FORMS & RESOURCES

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Referral List
(updated 9/2020)
New Patient Packet
Policies & consents
Release of Information (ROI)
Medical records release
Couples/Family Consent
Consent for couples & family
Controlled Substance
Agreement & responsibility
Telehealth Agreement
Telehealth agreement
Consent For Minors
Minor of divorced parents
Court Policy
Court policy & acknowledgment
HB2502 Form
For first responders
LGBTQ+ Resources
LGBTQ+ resources
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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)

 

CLINIC POLICY

Our providers DO NOT (1) work with court related or court ordered counseling or treatment, (2) participate in custody issues including writing reports for families, and (3) fill out disability paperwork unless the patient has been seen by our providers for a minimum of 3 scheduled appointments. In addition, a billable appointment needs to be made to complete the disability forms in person between the provider and patient.

NO SHOW/LATE CANCELLATION POLICY

NOTE: 1) Fees assigned if patient NO SHOW or LATE CANCEL appointment. A late cancellation is a confirmed cancellation by phone or email during working hours at least 24-hours (1 business day) prior to scheduled appointment,

2) for Monday appointments, cancellation will NOT BE waived if received after Friday 12pm.

For INTAKE appointments, a FEE of $150 will be imposed and payable on rescheduled appointment or earlier. 

For FOLLOW-UP appointments, a FEE of $75 will be imposed and payable on next scheduled appointment or earlier.

MEDICATION REFILL POLICY

All refill requests must be submitted to REFILL@LHPSYCH.COM.

Refill request takes SEVEN (7) BUSINESS DAYS to process.

Our office DOES NOT accept medication refill request by phone.

NO SAME DAY REFILLS, without exception.

Our office DOES NOT check emails on the weekends.

Hence, refill requests received on the weekend will be reviewed on next available business day.

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FAX: (480) 454-1085

MAIN OFFICE:

4001 E Baseline Rd Ste 204

Gilbert, AZ 85234