Terms & Conditions

 Services

Mindful Oasis, LLC provides psychiatric assessment, treatment, medication management and psychotherapy. During your initial appointment, your provider will complete a comprehensive psychiatric assessment and provide diagnostic and treatment recommendations. Medications may be prescribed if indicated. Referrals to external providers may be made for care outside the scope of services offered at Mindful Oasis. Psychiatric services provided at Mindful Oasis are medication-based and include Brief psychotherapy Services.

I understand that my provider does not provide urgent or emergency psychiatric evaluations. For urgent mental health concerns or emergencies, I agree to use the following resources:

• Call 911 or go to the nearest emergency room immediately for emergencies.
• Call 988 or text HOME to 741741 to access The National Suicide Prevention Hotline.

Initial Psychiatric EvaluationThe first appointment is an evaluation. At the end of the initial psychiatric evaluation, the Mindful Oasis LLC provider may determine that it would be best for you to be referred to another provider based on your clinical needs and/or treatment goals. Attending the initial psychiatric evaluation is not a guarantee that you will be scheduled for a second appointment or that any medication will be prescribed.

The Process Of Evaluation, Treatment, And Scope Of Practice
Engaging in psychiatric care can provide symptom relief, emotional well-being, and improved relationships. Achieving these benefits requires active participation, honesty, and patience. Mindful Oasis LLC will seek your feedback on treatment progress and expects open, honest responses. Discussions during treatment may bring up difficult emotions, and medication adjustments may take time. Addressing mental health concerns may lead to lifestyle decisions with potential challenges. While some experience quick improvements, others progress gradually—outcomes cannot be guaranteed.Mindful Oasis LLC utilizes evidence-based methods such as cognitive-behavioral therapy (CBT), psychodynamic therapy, existential therapy, humanistic approaches, and psychoeducation. Treatment may include therapy, medication, or both, depending on your needs. As a PMHNP in Virginia, I practice under the Virginia Board of Nursing and Medicine guidelines, maintaining a collaborative agreement with a licensed physician to ensure safe, effective care.

PSYCHOTHERAPY Psychotherapy is a powerful tool for improving relationships, reducing stress, and fostering self-awareness. It requires effort from both therapist and client, and success depends on the severity of concerns, introspective ability, and motivation.The process may surface distressing emotions like guilt, anxiety, or sadness, sometimes impacting relationships. If this occurs, addressing it in therapy is crucial. These feelings are typically temporary. At your initial visit, I will review your concerns and background, share my impressions, and discuss treatment options. Some individuals benefit from psychotherapy alone, while others require a combination of therapy and medication.A strong therapist-client fit is essential for effective treatment. If I am not the right provider for you, I will gladly offer referrals.

MEDICATION MANAGEMENT Medication may be appropriate when symptoms significantly impact daily functioning and psychotherapy alone is insufficient. If medication is indicated, I will explain all available options, including dosage, benefits, side effects, drug interactions, and withdrawal risks. You will have the information needed to make an informed decision. For clients already receiving therapy elsewhere, I will coordinate care with your therapist (with your consent). Effective treatment requires adherence to dosage, follow-ups, and sometimes lab monitoring.

I advocate for a bio-psycho-social approach, considering biological, psychological, and social factors for comprehensive care.

FREQUENCY & DURATION OF VISITS

The treatment structure is determined collaboratively. If medications are prescribed or adjusted, a two-week follow-up is recommended to monitor effects. If symptoms improve, visits may be scheduled monthly or, for maintenance therapy, every three months. Psychotherapy sessions are most effective when held weekly or biweekly, though alternative structures can be discussed based on your needs.

TREATMENT PLANS

Mindful Oasis LLC will outline treatment goals, expected outcomes, and the therapy/medication plan. If you have any questions about procedures, risks, or my qualifications, please ask. You also have the right to explore alternative treatments.

Provider-Patient Relationship and Rights

The therapy and medication management services we offer involve a relationship between you and your provider, with both parties having defined rights and responsibilities. It is important for you to understand your rights and responsibilities, as well as the legal limitations that exist. As your provider, Mindful Oasis, LLC has corresponding obligations towards you. The following sections outline your rights and responsibilities:

Goals of Services

Provider-Patient relationships have various objectives, including long-term goals such as enhancing your quality of life, fostering self-actualization, and developing mindfulness. Short-term goals may involve reducing anxiety and depression symptoms, improving relationships, modifying behavior, or addressing substance abuse. While your provider may offer suggestions on how to achieve these goals, the ultimate decision rests with you. Sometimes, clients may be court-ordered, where the court’s influence may impact the goals.

Risks and Benefits of Therapeutic Services

Therapy and medication management can evoke unpleasant memories or emotions due to their personal nature. It is important to note that there are no guarantees of specific outcomes, and progress may occur gradually or experience setbacks. Active effort and engagement beyond the therapy sessions are essential for maximizing success. Despite the challenges, therapy and medication management offer numerous benefits, such as developing coping mechanisms, behavioral changes, symptom reduction, improved quality of life, anger management, and mindfulness skills.

TERMINATION:

At Mindful Oasis, LLC, we are committed to providing high-quality mental health care, but there may be circumstances that require the termination of the provider-patient relationship. Termination may occur due to failure to follow treatment recommendations, non-compliance with the treatment plan, failure to pay for services, frequent cancellations or repeated no-shows, inappropriate or threatening behavior, the provider’s determination that another clinician may better meet the patient’s needs, resolution of the patient’s condition, or the provider’s retirement, relocation, or practice closure. When termination is necessary, the patient will receive a formal written notice,with a copy placed in their medical record. This notice will include the reason for termination and the final date of service. Patients will be provided with a list of alternative mental health providers and referral resources, and reasonable efforts will be made to assist with the transition if requested. For patients receiving medication management, instructions will be provided regarding ongoing care, including necessary refills to ensure a safe transition. Medical records will be transferred to a new provider upon request with proper authorization. If a patient chooses to discontinue care or fails to attend scheduled appointments, a written acknowledgment of termination may be sent, and further treatment recommendations will be included if deemed necessary. This policy ensures ethical and professional termination while prioritizing patient well-being and continuity of care.

I understand that my care may be terminated, and I may be referred elsewhere if I do not follow treatment recommendations. These include, but are not limited to:

• Failing to complete necessary labs or urine drug screens as requested.
• Failing to disclose full and accurate medical history, including recent hospitalizations or updates to my care.
• Withholding important information that may impact my treatment plan.
• Engaging in inappropriate behavior, whether in person or virtually, toward any employee of Mindful Oasis.
• Failure to Pay for services
• Failing to attend follow-up appointments within the recommended time frame.
• Failing to take medications as prescribed.
• Failing to follow through with referrals or recommended higher levels of care.
• Not adhering to patient responsibilities as outlined in this agreement.
• Cancelling or failing to show for 2 appointments without a valid reason
• Refusing to be an active participant in the treatment process

I understand that I have the right to decline further participation in or recommended treatment at any time. I also understand that I may request my psychiatric file be closed at any time, either verbally or through secure communication.

Non-Voluntary Discharge Policy:

• • A non-voluntary discharge may be given to the patient at any time via a mailed termination letter.
  • Reasons for termination include, but are not limited to:

• Non-compliance with treatment
• Violence or perceived threat of violence
• Physical or verbal intimidation
• Abuse towards any staff, clients, persons including family or friends associated with Mindful Oasis, LLC

• • If necessary, local law enforcement may be contacted.

Confidentiality & Legal Disclosure

Confidentiality All information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your written permission except where disclosure is required by law. 
I understand that Mindful Oasis maintains the highest standards of confidentiality and complies with all applicable legal and ethical requirements.

WHEN DISCLOSURE IS REQUIRED OR MAY BE REQUIRED BY LAW: Mindful Oasis LLC is obligated to comply. Some circumstances where disclosure is necessary include situations where there is a reasonable suspicion of child, dependent, or elder abuse or neglect; when a client presents a danger to themselves, others, property, or is gravely disabled; or when a client’s family members inform Mindful Oasis LLC that the client poses a danger to others. Disclosure may also be required if legal proceedings are initiated by or against the client. If a client places their mental health status at issue in litigation they have initiated, the defendant may have the right to obtain psychotherapy records or testimony from Mindful Oasis LLC providers. In cases of couples or family therapy, or when different family members are seen individually over time, confidentiality and privilege do not apply between the couple or among family members unless explicitly agreed upon. Mindful Oasis LLC providers will use their clinical judgment when determining what information may be disclosed in these circumstances. Records will not be released to any outside party unless authorized by all adult parties involved in family or couples therapy, except when required by law. While every effort will be made to obtain the client’s authorization before disclosing psychotherapy records, in some cases, a judge may order the release of records or require a provider from Mindful Oasis LLC to testify regarding therapeutic treatment.

There is no guarantee of confidentiality under the following conditions:

• If your provider suspects imminent danger of harm to self or others, or abuse/neglect of a child or elderly person (providers are mandated reporters). Protective actions may include notifying the potential victim, contacting the police, or seeking hospitalization.
• If a court orders the release of information.
• If a malpractice lawsuit or billing dispute is initiated by the patient.
• If the insurance company requests case details (e.g., for medication prior authorization).
• If payment is made by credit card, the practice name may appear on the statement.
• Between providers and administrative staff, or during professional consultations (identifying information will not be shared during peer consultations).

I understand that my provider may consult with other professionals (e.g., medical doctors, nurses, or administrative staff) within Mindful Oasis to support my care. My clinical information, including relevant history such as substance use, will be documented in my chart.

I understand that I may rescind this authorization for consultation with Mindful Oasis staff at any time by providing written or verbal notice.

Health Insurance & Confidentiality of Records

Disclosure of confidential information may be required by your health insurance carrier, HMO, PPO, MCO, or EAP in order to process claims. If you instruct Mindful Oasis LLC, only the minimum necessary information will be communicated to the carrier. However, Mindful Oasis LLC has no control over or knowledge of what insurance companies do with the information submitted or who may have access to it.

You should be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk to your confidentiality, privacy, and future ability to obtain health or life insurance or even employment. Mental health information is often entered into large insurance company databases and may be reported to the National Medical Data Bank. The security of these databases is always in question, as electronic records are inherently vulnerable to hacking and unauthorized access. Additionally, medical data has been legally accessed by law enforcement and other agencies, further putting your information at risk.

RECORDS AND YOUR RIGHT TO REVIEW THEM:

Both the law and the standards of Mindful Oasis LLC require that treatment records be kept for at least six (6) years after the last patient encounter. For minors, records are retained until the patient turns 18 plus six (6) additional years, but no fewer than ten (10) years total from the last date of service.

Please note that clinically relevant information from emails, texts, and faxes are part of the clinical records. Unless otherwise agreed to be necessary, Mindful Oasis LLC retains clinical records only as long as is mandated by Virginia law. If you have concerns regarding the treatment records, please discuss them with Mindful Oasis LLC. As a client, you have the right to review or receive a summary of your records at any time, except in limited legal or emergency circumstances or when Mindful Oasis LLC assesses that releasing such information might be harmful in any way. In such a case, Mindful Oasis LLC will provide the records to an appropriate and legitimate mental health professional of your choice. Considering all of the above exclusions, if it is still appropriate, and upon your request, Mindful Oasis LLC will release information to any agency/person you specify unless Mindful Oasis LLC assesses that releasing such information might be harmful in any way. When more than one client is involved in treatment, such as in cases of couple and family therapy, Mindful Oasis LLC will release records only with signed authorizations from all the adults (or all those who legally can authorize such a release) involved in the treatment. If you wish to release your records, you must sign a release of information form specifying the information to be disclosed and to whom. If you anticipate involvement in a court case, it is recommended to discuss this fully before waiving your right to confidentiality. If your case requires your provider’s participation, you will be responsible for covering the required professional time.

Medical Records/Documentation:

• All communication and clinical treatment will be documented in the patient chart, per legal and professional standards.
• Patients are entitled to receive a copy of their records upon request.
• If the provider believes viewing the records may be harmful, a treatment summary may be provided instead.
• Records will only be released with a completed and signed Consent for Release of Confidential Information form.
• Requests must be submitted via fax, mail, or in person (email requests/attachments are not accepted).

Litigation

Sometimes patients become involved in litigation while they are in therapy or after their therapy or medication management treatment has ended. In some cases, either the patient or the opposing attorney in a legal case may request that therapy records be disclosed to the legal system. Due to the nature of psychotherapy and psychiatric care, which often involves open and full disclosure of personal matters, patient records are generally confidential and private in nature.

It is important to understand that serious consequences can result from disclosing therapy records in a legal setting. Such disclosures may negatively impact custody disputes, legal proceedings, or other matters and could also harm the therapeutic relationship. If you or an opposing attorney are considering requesting the disclosure of records from Mindful Oasis LLC, we will do our best to discuss the risks and benefits of doing so before proceeding.

As noted in this document, you have the right to review your own psychotherapy records at any time. (See also the relevant section above: “When Disclosure is Required or May Be Required by Law.”)

Consultation

Mindful Oasis LLC providers regularly consult with other professionals regarding client care to ensure the highest quality of treatment. However, each client’s identity remains completely anonymous, and confidentiality is fully maintained throughout the consultation process.

Paperwork/Letters: Completion of paperwork may take up to 10 business days, including Social Security Disability Insurance (SSDI) and Emotional Support Animal (ESA) paperwork. A minimum of six sessions must be completed with the patient before assistance with SSDI paperwork can be provided.

Subpoena for Witness: If a provider is subpoenaed for court or deposition, an hourly fee applies (see Fee Form). This fee covers preparation, travel, waiting, testifying, or any other time related to the subpoena. Payment in full is required five business days prior, with any remaining balance due within 48 hours after. If the court hearing or deposition is canceled less than five business days prior, the full fee will still be charged (including preparation time and two additional hours).

 Communication & Emergency Procedures

Contacting Our Office & Emergency Procedures If you need to contact Mindful Oasis LLC between sessions, please leave a message at the answering service (757-720-1040), and your call will be returned as soon as possible. Mindful Oasis LLC checks messages a few times during the daytime only, unless the provider is out of town.

Providers may not always be immediately available by phone, especially when with clients or otherwise occupied. Our office manager answers the phone Monday through Thursday, 10 AM to 4 PM. However, there may be times when even this is not possible. During these times, you can leave a voicemail, and we will return your call as soon as possible.

For secure communication, please use the Klara messaging platform or the patient portal. These platforms are checked regularly. If you wish to opt out of Klara messaging, please inform your provider.

For emergencies, do not use voicemail, Klara, or the patient portal. Instead, contact the appropriate emergency services:

• Psychiatric Emergency Services, Virginia Beach: (757) 385-0888
• 24-hour crisis line: 988
• Police/Emergency: 911

E–Mails, Cell Phones, Texts, Computers, and Faxes

Computers and unencrypted e-mail, texts, and e-faxes communication can be relatively easily accessed by unauthorized people and therefore can compromise the privacy and confidentiality of the information used in such communications. Servers and telecommunication companies often have direct and unlimited access to all the information contained in the e-mails, texts, and e-faxes that use their services.

To protect the confidential information of clients, Mindful Oasis LLC ensures that all patient records and sensitive data are securely stored within Tebra, a HIPAA-compliant electronic health records (EHR) system. Mindful Oasis LLC does not permanently store patient information on local computers. Any patient data that is temporarily handled for upload is stored on a secure, encrypted virtual drive and deleted after transfer.

For secure communication, Mindful Oasis LLC uses Klara and the Tebra Patient Portal, both of which provide encrypted, HIPAA-compliant messaging. Clients are advised not to use email, text messages, voice mail, or fax for sensitive information, as these methods are not secure. These communication methods should also not be used for emergencies, as they will not be accessed in a timely manner.

I acknowledge that secure messaging through Klara or the patient portal is intended for non-urgent issues only, and it may take 24 to 48 hours during regular business hours for my provider to respond. For time-sensitive matters, I will ensure that I regularly check these platforms for updates that may affect my health or treatment.

For urgent mental health concerns, I will contact the appropriate emergency services:

• Call 911 or go to the nearest emergency room for emergencies.
• Call 988 or text HOME to 741741 to access The National Suicide Prevention Hotline.

I understand that it is recommended – though not required – that I provide consent for the provider to communicate with a family member and/or significant other to coordinate my care.

EMERGENCY:

In the event of an emergency during therapy or a medication management appointment, or at any time after termination of services, if Mindful Oasis LLC becomes concerned about your personal safety, the possibility of you harming yourself or others, or your ability to receive proper psychiatric care, we will take all necessary actions within the limits of the law to protect you and those around you. This may include making reasonable efforts to prevent harm and ensuring that you receive appropriate medical care. If necessary, we may also contact the individual you have listed as your emergency contact on your biographical sheet.

Emergency Coverage: Mindful Oasis, LLC does not provide care outside of regular business hours. Patients experiencing an emergency should call 911 or visit the nearest emergency room.

Vacation Coverage: Another provider may provide vacation coverage for non-emergency questions or concerns during regular business hours (Monday-Thursday, 10 AM-4 PM). ADHD/stimulant or other controlled medication refills may not be available during your provider’s vacation period

 Social Media, Recording, & Internet Policies

Internet Searches: In principle, Mindful Oasis, LLC does not use search engines to look up information about clients. However, in extreme situations that involve the well-being and safety of the client—such as when the provider has reason to suspect the client is in crisis, or if the client has not shown up to sessions and has not communicated—exceptions may be made. In such cases, searching the internet for pertinent information about the client or attempting to find alternative ways to contact the client may be necessary to ensure their welfare. These extraordinary incidents will be fully documented and discussed with the client when possible.

Social Media Policy:

At Mindful Oasis, LLC, we take confidentiality, privacy, and maintaining professional boundaries very seriously. To protect these, providers do not accept friend requests from current or former clients on social networking sites, as doing so could compromise privacy and the therapeutic relationship. If you have any questions about this policy, you are encouraged to discuss them during sessions. Providers may use social media to share mental health resources or updates but will not follow clients to maintain privacy. To ensure clear boundaries, social media should not be used for communication, and clients should use phone, patient portal, Klara, or email for administrative matters.

To protect both the client and provider’s privacy and to maintain the integrity of the therapeutic relationship, we follow these principles regarding social media:

• We do not engage with clients on social networking sites. Friend requests on platforms like Facebook will be denied, and any communication on social platforms such as Messenger will be ignored.
• Mindful Oasis, LLC has an official Facebook page for professional purposes, including updates and blog posts. Clients are welcome to view and share these posts, but they will not be able to become “fans” or interact directly.
• Mindful Oasis, LLC may have a professional Twitter account used for clinical news. Clients are not expected to follow this account. While clients have the right to follow any public accounts, they should consider safer options such as using an RSS feed or a locked Twitter list. The provider does not follow past or current clients on social media.
• The preferred method of contact between sessions is phone. This is especially important for discussing any therapeutic matters.
• For brief administrative communications, such as rescheduling a session, email or Klara may be used. However, email should not be used to discuss therapy-related issues for confidentiality reasons.
• Avoid using SMS (text messaging) or social media messaging (WhatsApp, Messenger, etc.) to contact the provider. These are not secure communication methods.
• The provider will not see or monitor any materials clients post on social media. However, if a client wishes to bring something relevant to treatment, they are welcome to discuss it during a session.

Audio or Video Recording:

Unless explicitly agreed to by all parties beforehand, there shall be no audio or video recording of therapy sessions, phone calls, or any other services provided by Mindful Oasis, LLC.

 Telemental Health (TMH) Services

Telemental Health

Telemental health (TMH) refers to clinical services provided via phone or videoconference. TMH is offered to provide access to psychiatric services for patients who are physically located in the state of Virginia but are unable to, or prefer not to, attend in-person sessions. TMH services may not be appropriate or the best choice for certain individuals for reasons including, but not limited to: heightened risk of harm to oneself or others, lack of access to or difficulty with communications technology, significant disruptions in communication services, or the need for more specialized or intensive care. In such cases, the provider will recommend in-person care or provide referrals to appropriate resources.

I understand there are risks associated with engaging in TMH services, including but not limited to: sessions could be disrupted, delayed, or communications distorted due to technical failures; TMH involves alternative forms of communication that may reduce visual and auditory cues and increase the likelihood of misunderstanding one another; the provider may determine that TMH is not an appropriate treatment option or discontinue TMH treatment at any time if my condition changes, TMH presents barriers to appropriate treatment, or if other outlined criteria are met; and security protocols could fail, allowing unauthorized access to my confidential information.

I understand that I may only engage in TMH sessions when I am physically located within the state of Virginia. The provider will confirm my location at the start of each session. I agree to engage in sessions only from a private location where I will not be overheard or interrupted. Neither I nor the provider will record any sessions.

If I show signs that my symptoms are worsening or that I may be in danger, and I fail to respond to messages, I grant Mindful Oasis permission to contact my emergency contact to verify my well-being.

If I display indicators that I may be at serious risk for self-harm or harm to others, I understand that Mindful Oasis is required to contact the law enforcement agency closest to my location to ensure my safety.

Telehealth Appointments: We offer confidential, HIPAA-compliant video appointments. In-person visits may be required depending on the medication being prescribed (e.g., psychostimulant medications).

Electronic Scribe Software Disclaimer

At Mindful Oasis, LLC, we utilize AI-powered scribe technology to assist with documentation during sessions, enhancing efficiency while allowing providers to focus on patient care. This technology is HIPAA-compliant and adheres to all privacy and security regulations, ensuring that patient information remains secure and is used solely for documentation purposes. The AI scribe does not record, store, or save audio from sessions but functions in real-time to generate clinical notes, which are then reviewed and finalized by the provider. Patients will be informed of its use, and by receiving care at Mindful Oasis, they consent to AI-assisted documentation. However, the AI scribe is a tool for documentation only and does not replace provider judgment, clinical decision-making, or direct patient communication. All notes generated are carefully reviewed, edited, and finalized by the provider before being entered into the medical record. This policy ensures transparency, security, and ethical documentation while maintaining the highest standards of patient privacy and confidentiality.

 Medication & Controlled Substances Policy

Medication During my initial/follow up appointment, the provider will discuss medication treatment options, potential side effects, and how to manage them. I understand that I should not share my medication with anyone else or receive psychiatric medications from other providers without first informing my provider at Mindful Oasis.

I understand that alcohol, marijuana, and other drugs may compromise my treatment and make my symptoms worse. Mindful Oasis recommends that I abstain from these substances while in treatment. Additionally, combining alcohol, marijuana, or opiates with benzodiazepines or hypnotics (such as Ambien) is particularly dangerous and can be fatal. I understand that if I misuse medications or combine them with other substances, I may be asked to provide a urine drug screen, and my medications may not be refilled.

Controlled Substance Prescription Policy

At Mindful Oasis, LLC, we look forward to being a part of your healthcare team and value your well-being. Because of this, please be advised that our prescribers:

• ADHD Medication Requirements:
  • May require psychological testing validating a diagnosis of ADHD, completed within the last five years, prior to the initiation of psychostimulant medication.
  • Psychostimulant medication will only be prescribed at the discretion of your provider based on their clinical decision-making.
  • Scheduling an Initial Psychiatric Evaluation is not a guarantee of receiving an ADHD diagnosis and/or psychostimulant medication.
• Benzodiazepine Policy:
  • Do not initiate or maintain the long-term use of benzodiazepines (Xanax, Ativan, Clonazepam, Valium, etc.).
  • We are happy to work with you to devise an effective treatment plan that incorporates therapies validated for long-term use.
• Prescription Monitoring & Controlled Substances:
  • The Virginia Prescription Monitoring Program (PMP) is used to obtain patient prescription histories.
  • It is up to the prescriber to determine if a controlled substance should be prescribed, and there is no guarantee that any controlled substances will be prescribed.
• Controlled Substance Agreement:
  • Patients will be required to sign this agreement annually.
• Refill Policy:
  • The patient is responsible for their medication.
  • If medication is lost or stolen, early refills will not be given.
  • The provider reserves the right not to prescribe this medication again.
• Abuse / Misuse Policy:
  • If at any time it is determined that a patient is not taking prescribed controlled substance medications as directed or is overtaking the medication, this will be discussed with the patient.
  • The provider reserves the right to:
    • Non-voluntarily discharge the patient
    • Refer them to a substance abuse/detox clinic
    • Not refill the medication
  • The provider is not required to give a 30-day supply of medication in the case of misuse.
• Drug Testing Requirements:
  • All patients taking controlled substances must be willing to take a random drug test.
  • Patients may be required to go to LabCorp for a formal drug screen (hair, urine, or blood) within 24 hours of request.
  • If non-compliant, the provider reserves the right to issue a non-voluntary discharge without a medication refill.
• Failure to Disclose / Failed Drug Test Policy:
  • If a patient tests positive for a substance (over-the-counter, legal, or illegal) with potential for abuse that was not previously disclosed to the provider, this will be discussed with the patient.
  • The provider reserves the right to issue a non-voluntary discharge without a medication refill.

Refills

I understand that if I do not follow up as recommended, my medication may not be refilled until my next appointment.

No charge for refill requests made during regular business hours (Monday-Thursday, 10 AM-4 PM). Refill requests may take up to two business days to complete.

• A fee will be charged for:
  • Urgent refill requests made outside of business hours (weekends/holidays).
  • Refill requests when a patient has not scheduled or attended a follow-up appointment and needs medication until the next available appointment.

I understand that ADHD medications (e.g., Adderall) and benzodiazepines (e.g., Klonopin) always require a monthly appointment, and if I miss or cancel my follow-up appointment, my controlled medication may not be refilled until my next appointment.

Payment and Billing Policy

I acknowledge and understand that I am responsible for all charges associated with any services rendered to me or any individual for whom I am listed as the responsible party. As a courtesy, your benefits will be verified by Mindful Oasis, LLC prior to your appointment(s). However, it is the responsibility of the patient to verify benefits associated with their specific health plan prior to appointments and to review the Explanation of Benefits (EOB) forms received to ensure that cost associated with appointments are well communicated and understood.
I hereby agree to pay the insurance deductible, co-payment, co-insurance, or self-pay amount as services are provided. I understand that if I do not provide my insurance information at least 48 hours prior to my initial or follow-up visit, I will be required to pay the self-pay rate at the time of service until insurance information is provided. If for any reason there is a balance due on my account, I agree to pay promptly upon receipt of the statement.

PAYMENTS & INSURANCE REIMBURSEMENT:

Clients are expected to pay the standard fee of $350 for an initial evaluation, $100 for a 15-minute medication management follow-up, $150 for a 30-minute medication management visit with psychotherapy, $200 for a 45-minute individual therapy session, and $250 for a 45-minute medication management visit with psychotherapy at the end of each session or at the end of the month unless other arrangements have been made. Telephone conversations, site visits, writing and reading of reports, consultation with other professionals, release of information, reading records, longer sessions, travel time, etc., will be charged at the same rate, unless indicated and agreed upon otherwise.

Service Fees:

• Initial Evaluation (55 minutes): $350
• Medication Management Follow-up (15 minutes): $100
• Medication Management Visits with Psychotherapy (30 minutes): $150
• Therapy only, individual (45 minutes): $200
• Medication Management Visits with Psychotherapy (45 minutes): $250
• Document Preparation: $80 base fee + $80 for every additional 15 minutes
• Consultation with Third Party (20 minutes): $175
• Medical Testimony: $400 per hour, including travel

Please notify Mindful Oasis LLC if any problems arise during the course of therapy or medication management regarding your ability to make timely payments. Clients who carry insurance should remember that professional services are rendered and charged to the clients, not to the insurance companies. Unless agreed upon differently, Mindful Oasis LLC will provide you with a copy of your receipt on a monthly basis, which you can then submit to your insurance company for reimbursement if you so choose.

As indicated in the section Health Insurance & Confidentiality of Records, you must be aware that submitting a mental health invoice for reimbursement carries a certain amount of risk. Not all issues, conditions, or problems addressed in medication management/ or psychotherapy sessions are reimbursed by insurance companies. It is your responsibility to verify the specifics of your coverage.

If your account is overdue (unpaid) and there is no written agreement on a payment plan, Mindful Oasis LLC can use legal or other means (courts, collection agencies, etc.) to obtain payment.

Insurance

If you have health insurance, it often includes some coverage for mental health treatment. Most insurance companies require authorization for a clinical diagnosis, and your provider may need to provide additional clinical information that becomes part of the insurance company’s records. By signing this agreement, you consent to your provider sharing the requested information with your insurance carrier if you plan to use insurance.

Preauthorization from the insurance company may be necessary before they cover medication management and therapy fees. Failure to obtain the required authorization may make you responsible for the full payment. Please note that while we try to obtain authorization as a courtesy, it is ultimately the patient’s responsibility to fully understand their insurance policy, obtain any necessary authorizations, and ensure their visit is covered before the appointment. It is also important to notify our office of any changes to your insurance, as we are obligated to collect the self-pay rate if there is a lapse in coverage without prior notification. Many policies require patients to cover a percentage of the fee, payable at the time of the visit. Additionally, some insurance companies have deductibles, which are out-of-pocket amounts that patients must pay before the insurance company begins covering services.

 Scheduling, Cancellations & No-Show Policy

New Clients:

At Mindful Oasis, all new clients are required to have a credit card on file, stored securely in our HIPAA-compliant system. A one-time $50 reservation fee will be charged to hold your scheduled date and time. This fee will be applied toward any initial copay, coinsurance, deductible, or labs. If no out-of-pocket expenses are incurred, the fee will be refunded. However, in the event of a no-show, this fee will not be reimbursed.

• Cancellations or rescheduling for new clients must occur at least 48 hours prior to the scheduled date via the patient portal or by contacting 757-720-1040.

Once I have scheduled a psychiatry intake appointment, I understand that I will receive a welcome email from Mindful Oasis with instructions to:

• Complete all required intake paperwork, including an online assessment.
• Review and sign the Informed Consent to Receive Psychiatric Treatment, Permission for Medical Treatment, Psychiatry Telehealth Consent Form, and any other applicable forms (Medical history, screening forms, etc.).
• New clients must complete their New Client Paperwork at least 48 hours prior to their appointment. Failure to do so may result in appointment cancelation/ rescheduling of the visit, $50 reservation fee will not be reimbursed.
• Links to upload identification documents, including a valid ID and insurance card, will be provided with the intake paperwork.

I understand that signing these forms is required for psychiatric treatment at Mindful Oasis. If I fail to review and sign the forms at least 48 hours prior to my intake appointment, my appointment may be rescheduled or canceled.

If I decline to sign the required forms, I understand that I cannot initiate or continue to receive psychiatric treatment at Mindful Oasis, and I will be referred to appropriate external mental health services.

Missed Appointments, Cancellations, and Late Arrival

All visits require prior payment authorization for any out-of-pocket expenses. Copays/self-pay dues will be automatically collected at least 24 hours in advance of the scheduled appointment via Credit Card On File. Payment for all services must be completed prior to the start of the visit.

If I am unable to make a scheduled appointment, I understand that I must cancel at least 24 hours in advance (weekends not included) or I will be charged a $100 no-show/late cancellation fee. If my appointment is on a Monday, I must cancel by the same hour on the preceding Friday.

A no-show is defined as:

• Missing an appointment without notifying Mindful Oasis.
• Canceling an appointment with less than 24 hours’ notice.
• Arriving late to an appointment (intake or follow-up) beyond the 10-minute grace period for in-person appointments or beyond the 5-minute grace period for virtual appointments.

If I arrive beyond the grace period, I may not be seen, and Mindful Oasis may reschedule my appointment, and I may be charged the no-show fee. If I fail to show up for three or more appointments without notice or fail to follow up as recommended by my psychiatric provider, I understand that I may be terminated from the practice referred elsewhere for services.

For Medicaid Patients Only:

• New patient appointments will be canceled without the option to reschedule in the event of a no-show, late cancellation, or failure to complete required paperwork at least 48 hours prior to the scheduled appointment.
• For follow-up appointments, Medicaid patients are allowed up to 2 no-shows; any additional no-shows will result in dismissal from the practice.

Scheduling and Payment Policies

I understand that all fees, including copays, deductibles, and self-pay fees, will be automatically collected at least 24 hours in advance of my scheduled appointment. I agree to maintain a valid credit card on file for these payments, and I am responsible for updating the office with any changes to my payment information.

If an attempt to collect my copay fails, the office will make reasonable efforts to contact me; however, it remains my responsibility to ensure my payment method is valid. If my copay is not successfully collected 24 hours before my appointment, my appointment may be canceled.

In the event that my appointment is canceled due to provider unavailability or office closure after payment has been collected, a credit will be applied to my account for a future appointment. If the credit is not used within 30 days, it will be refunded to the card on file.

By scheduling an appointment, I acknowledge and agree to these terms.

For any canceled or missed appointments without proper notice (24 hours in advance), a $100 cancellation fee will be charged to my card on file.

Valid Identification and Insurance Card Requirement

I understand that I must present both a valid form of identification and my insurance card for my initial intake appointment, whether in person or via telehealth.I understand that the ID and insurance card I provide must:

• Be uploaded via the provided link along with my intake paperwork at least 24 hours in advance.
• Be a hard copy (not a photo or digital copy) if presented at the appointment.
• Be valid and active (not expired).
• Display a clear and recent photo sufficient for identification.

If I fail to complete the upload process as described or fail to provide valid ID and insurance information, my intake appointment will be rescheduled, and depending on appointment availability, it may take several weeks to reschedule.

Limits

I understand that there is no limit to the number of sessions I may receive as part of my psychiatric care at Mindful Oasis. I understand that my provider can assess and treat a range of general psychiatric disorders, including but not limited to: depression, mania/hypomania, bipolar mood disorder, anxiety, panic attacks, OCD, PTSD/trauma, and insomnia.

However, I understand that there are circumstances where I may be referred to external providers for treatment based on my provider’s clinical judgment. These circumstances may include, but are not limited to:

• Assessment and diagnosis for ADHD, Autism, or other complex diagnostic cases.
• Unstable or severe, persistent disorders that require more frequent visits than once per month.
• Drug and alcohol withdrawal.
• Active eating disorders.