Practice Policies and Patient Responsibilities Agreement

PURPOSE OF THIS AGREEMENT

This document outlines the policies, expectations, and responsibilities required to receive care from Starry Psychiatry & Wellness PLLC. These policies are designed to:

• support safe, effective, and evidence-informed psychiatric care
• establish clear expectations between patient and provider
• support clinical decision-making, continuity of care, and risk management
• promote efficient and consistent practice operations

GENERAL PATIENT RESPONSIBILITIES

I agree to:

• provide accurate, complete, and current medical, psychiatric, medication, and substance use history
• inform the Practice of any changes in symptoms, medications, pharmacy, contact information, insurance, pregnancy status, hospitalizations, or major health events
• attend scheduled appointments and arrive on time
• follow treatment recommendations or discuss concerns openly with my provider
• complete requested labs, screenings, questionnaires, or other monitoring when clinically indicated
• communicate respectfully with providers and staff
• comply with Practice policies

Failure to meet these responsibilities may affect treatment planning, refill decisions, and continuation of care.

Appointments and Follow-Up Requirements

Stable patients are generally seen every 1–3 months depending on diagnosis, medication regimen, treatment response, and clinical stability. Patients starting a new medication, undergoing medication adjustments, or experiencing worsening symptoms are generally seen every 2–6 weeks until clinically stable.

Failure to maintain recommended follow-up appointments may result in delayed or denied medication refills, changes to the treatment plan, additional monitoring, or discharge from the Practice when ongoing care cannot be safely provided.

Medication Refill Policy

Medication refill requests must be submitted at least seventy-two (72) business hours before medication is needed.

• Refill requests should be submitted through the patient portal or your pharmacy.
• Requests received after business hours, weekends, or holidays will be reviewed on the next business day.
• Refills are provided only for patients who remain actively engaged in treatment and comply with recommended follow-up appointments and required laboratory monitoring.
• Controlled substances are generally not refilled early. Lost, stolen, damaged, or misplaced controlled substance prescriptions are generally not replaced.
• The Practice may require review of the Texas Prescription Monitoring Program (PMP), urine drug screening, pill counts, pharmacy verification, or additional monitoring when clinically appropriate.

Paperwork, Forms, and Administrative Requests

• Routine forms, school/work letters, and simple documentation: $25 per form.
• FMLA, disability, accommodation forms, treatment summaries, or similar administrative paperwork: $75 per form.
• Extensive reports, legal summaries, or records requiring substantial provider time: $150 per hour.

Please allow seven (7) business days after receipt of payment and all requested information for completion. Some requests may require an appointment.

Communication Policy

• Routine patient portal messages generally receive a response within two (2) business days.
• Portal messages, voicemail, email, and text messaging should not be used for emergencies.
• Medication changes, worsening symptoms, controlled substance requests, or complex medical concerns require a scheduled appointment.

Telehealth Requirements

Starry Psychiatry & Wellness PLLC currently provides telepsychiatry services. Patients must be physically located within the State of Texas at the time of each appointment unless otherwise permitted by law.

• Patients agree to provide their current physical location and an emergency contact at the beginning of every telehealth visit.
• Appointments should be conducted in a private location using a reliable internet connection.
• If technical problems prevent a safe visit, the appointment may be rescheduled or, if available in the future, converted to an in-person visit.

Missed Appointments

• Appointments should be cancelled or rescheduled at least twenty-four (24) hours in advance.
• Appointments cancelled with less than 24 hours' notice or missed without notice may be subject to a $75 missed appointment fee, unless prohibited by insurance requirements or applicable law.
• Patients arriving more than ten (10) minutes late may be asked to reschedule.

Laboratory Monitoring

Patients prescribed medications requiring laboratory monitoring are responsible for completing requested laboratory testing within the recommended timeframe. Failure to complete required monitoring may result in delayed refills, medication changes, or discontinuation of treatment when necessary for patient safety.

Financial Responsibility

A valid payment method may be maintained securely on file. Patients are responsible for charges not covered by insurance, applicable copayments, deductibles, coinsurance, and approved administrative fees.