Jennifer Irwin, MD

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Jennifer Irwin, MD PROCESS OF TREATMENT: Treatment goals will be discussed with you based on your condition, concerns, and challenges. Psychotherapy can be uncomfortable at times, while working toward your goals. Successful therapy happens with a joint effort between you and your physician. However, much of the responsibility for your health and well-being remains with you. If you are dissatisfied, please discuss your concerns with your physician. For certain conditions, medication can be helpful in treatment and will be discussed in your sessions as part of an integrative approach. This approach will include homework between sessions. Please bring a designated notebook and pen to all appointments. APPOINTMENTS: All sessions are arranged by appointment only. Please be prompt to best use the time reserved for you, as sessions cannot be extended if you arrive late It is your responsibility to remember and keep track of your appointments. Cancellations, less than 24-hours prior, and no-shows will be charged a fee. PLEASE UNDERSTAND I DO NOT PERFORM EVALUATIONS OR ASSESSMENTS FOR LEGAL PURPOSES, SOCIAL SECURITY DISABILITY, OR PSYCHOLOGICAL REPORTS. I DO NOT DO DISABILITY PAPERWORK. **I will provide chart notes, as needed, for disability. PHONE CALLS AND EMERGENCIES: Calls to our office are answered by our staff or our 24-hour answering service. Due to the nature of an outpatient practice, it may not be possible for us to respond immediately. If a situation requires an immediate response please ask our answering service for further instruction, call 911, or go to the nearest hospital emergency room. BILLING AND PAYMENTS: Payment is due for each session at the time it is held, unless we agree otherwise or unless you have insurance coverage. If you have insurance coverage your co-pay is due at the time of each appointment. The co-pay for mental health is often different from that for other medical visits. If you are uncertain about your co-pay I encourage you to contact your insurer. Ultimately, you are responsible for your account and are expected to pay your bill, whether insurance pays for a portion or not. INSURANCE: I am a contracted provider for many, but not all, local insurance companies. You should be sure to check with your insurer and my intake office to learn whether I am a provider for your plan. You should also learn whether you need a referral or preauthorization to be eligible for your mental health benefit, whether you have a separate annual deductible for mental health, and whether your mental health benefit has a maximum yearly number of visits or a maximum yearly dollar amount. My billing department will submit claims to insurance companies that I am contracted with. CHANGES TO THIS OFFICE POLICY: From time to time I may change the business policies described in this document; I will attempt to inform you of relevant changes. INFORMED CONSENT: Your signature below indicates that you have read the information in this document and agree to abide by its terms during our professional relationship.

* I acknowledge I have read the financial policy above and that I am responsible for all charges regardless of any insurance coverage I have. I understand that delinquent accounts may be assigned to a credit reporting collection agency and agree to pay for all legal costs and expenses including reasonable attorney fees. By signing this Acknowledgement, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.

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