Cancellation and No-Show Policy

• Cancellation must be made at least 24-hours prior to scheduled appointment

• Cancellation less than 24-hours are considered a “no-show”

• No-Show will result in a $50 fee

• Patients with three (3) or more no-shows in a 6-month period will be discharged from clinic

Payment Policy

• All patients must have a Headway.co account with payment method on file 24-hrs prior to appointment

• Self-pay patients must submit payment prior to the start of appointment

• Appointment will be canceled if Headway.co is not complete 24-hrs prior to appointment

• Future appointments will be canceled for any patient with an outstanding balance

• Patients with account balances unpaid after 30 days may be discharged from clinic

Controlled Medication Policy

• MPC does NOT prescribe any benzodiazepine medications, such as Xanax, Klonopin, Valium, Ativan, etc.

• Max 30-day supply per prescription

• Appointment is required for all refills; no early refills

• Urine drug screen may be required

Paperwork Policy

• Paperwork requests, such as FMLA or ESA letter, are only available for established patients

• A fee of $25 per page must be paid in full before completion of requested paperwork

Conduct Policy

• Any rude, aggressive, or threatening behavior towards staff will not be tolerated

• Such behavior may result in discharge from clinic

Medical Record Release Policy 

• A Release of Information (RoI) is required for all medical record requests

• Medical records faxed to another treatment provider are free of charge 

• Medical records will only be released directly to patients by certified mail

• Fee for paper medical records: $25 for the first 20 pages, $0.50 for each additional page

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