Psychiatry Practice Policies
Kinetic Mind LLC

Welcome to Kinetic Mind LLC. My goal is to provide collaborative, respectful, and
evidence-based psychiatric care in a safe and supportive environment. This document
outlines the policies, expectations, and professional standards that guide our work
together. Please review carefully and ask questions as needed.

Services may include psychiatric evaluation, diagnosis, medication management, and
related mental health treatment. If applicable, natural medicine facilitation services
require separate consent and screening.
Kinetic Mind LLC provides outpatient psychiatric care and is not a 24-hour crisis
service.

Your appointment time is reserved specifically for you. Because psychiatric
appointments involve medication management and clinical follow-up requirements,
missed visits impact both your care and access for other patients.
• A minimum of 48 hours’ notice is required to cancel or reschedule an appointment.
• Appointments canceled with less than 48 hours’ notice will result in a a fee that is
equivalent to the apointment type. Refer to fees and schedule tab for pricing. late
cancellation fee.
• Failure to attend a scheduled appointment without prior notice will result in a charge
of the full session fee.
• Insurance does not cover missed appointment fees. These fees are the patient’s
financial responsibility.
• Repeated late cancellations or no-shows may result in modification of scheduling
privileges or discharge from the practice.
Exceptions:
Fees may be waived at provider discretion in the event of true emergencies or
unforeseen circumstances.

Insurance and Payment Verification:
Insurance coverage and payment information must be verified through Headway at
least 48 hours prior to your scheduled appointment. Failure to complete verification
may result in cancellation or rescheduling at the practice’s discretion.
Payment Timing:
Payment is due at the time of your appointment.
You are responsible for:
• Copays, coinsurance, and deductibles
• Non-covered services
• Late cancellation or no-show fees
• Administrative/documentation fees
• Any balance not paid by insurance
A valid credit card must be maintained on file through Headway or the designated
billing platform. By signing this agreement, you authorize charges for amounts owed
at the time of service or for applicable policy-based fees.
Insurance verification does not guarantee payment. Patients are responsible for
understanding their insurance benefits.
Unpaid balances may result in suspension of scheduling and may be referred to
collections.
Administrative and Documentation Fees
The following fees apply when not covered by insurance:
• Disability/FMLA/SSD paperwork: $150 per form
• Emotional Support Animal (ESA) letter: $200
• Insurance prior authorization appeals (outside visit time): $75
• Short forms (1–2 pages): $50
• Moderate forms (3–5 pages): $100
• Extensive forms (over 5 pages): $250

The preferred method of communication is secure messaging through the CHARM EHR portal.
• Non-urgent messages are responded to within 72 hours (up to 3 business days).
• Extensive between-session communication exceeding 5 minutes may be billed at $55 per 15
minutes for private-pay or non-covered services.
This practice does not provide 24-hour crisis coverage.
Emergency Resources:
If you are experiencing suicidal thoughts, homicidal thoughts, or a psychiatric emergency, call 911,
contact Colorado Crisis Services at 1-844-493-8255, text TALK to 38255, or go to the nearest
emergency department.

Medication refills require appropriate follow-up.
• Refills are typically processed within 2–3 business days.
• Early refills are not guaranteed.
• Lost or stolen medications are not routinely replaced.
• Medication changes generally require an appointment.
Medication Management Follow-Up Policy
Ongoing medication management requires regular follow-up to ensure safety and
effectiveness.
Non-Controlled Medications:
• Every 2–4 weeks during initiation or dose adjustments.
• Once stable, at least every 3 months.
• Some stable patients may be seen every 3–6 months at provider discretion.
Controlled Substances (Schedule II–V):
• Every 2–4 weeks during initiation or dose changes.
• Once stable, at least every 1–3 months.
• Schedule II medications generally require visits at least every 3 months.
• Higher-risk patients may require more frequent visits.
The Colorado Prescription Drug Monitoring Program (PDMP) may be reviewed as
required by law.
Failure to maintain required follow-up may result in delayed refills, tapering,
discontinuation, or discharge from the practice.

Your health information is protected under HIPAA and Colorado law.
Exceptions to confidentiality include:
• Risk of harm to self or others
• Suspected abuse or neglect
• Court orders or legal requirements
• Medical emergencies
• Insurance billing and healthcare operations
Electronic communication carries inherent privacy risks despite reasonable
safeguards.
Discharge and Termination of Services
(Colorado-Specific)
Ending care is approached thoughtfully and ethically, with attention to continuity of
care.

Voluntary Discharge:
You may discontinue services at any time. A final visit is encouraged when possible to review
progress and discuss next steps.
Practice-Initiated Discharge:
Care may be terminated for any of the following:
• Repeated missed appointments
• Failure to maintain required medication follow-up
• Nonpayment or failure to maintain valid payment information
• Failure to complete insurance verification
• Violation of the Controlled Substance Treatment Agreement
• Prescription misuse or diversion
• Threatening or disruptive behavior
• Clinical needs exceeding outpatient scope
• Relocation outside licensed states
Except in cases involving immediate safety concerns, the practice will:
• Provide written notice
• Offer referrals when appropriate
• Provide emergency resources
• Provide urgent medication refills for a limited transition period (typically up to 30 days) when
clinically appropriate