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 complete a Headway.co account for billing purposes

• Headway requires all patients to keep a payment method on file

• Appointments will be canceled if Headway account is not complete and active 24-hours prior to appointment

• Payment is due at the time of service

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

• All new self-pay patients must submit payment prior to the start of appointment

Controlled Medication Policy

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

• Consistency with appointments is required

• No automatic refill is given on controlled medications

• PDMP will be checked at each refill and periodic urine drug screen is 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

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 mail

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

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