SERVICE AGREEMENT/CONSENT TO TREATMENT
To receive any services from Dr Scott, you must agree to the following terms and conditions. You must affirmatively give your consent by clicking on the box below labeled "I have read the terms and conditions of treatment and consent to them." You have the right to decline these terms and conditions, but in that case you will not be able to schedule an appointment nor receive any services from Dr. Scott.
1/ Dr Scott is not responsible for any misuse of the services and appointment time. Any inappropriate behavior that would, in Dr. Scott's sole professional judgment, permit termination of an in-patient office visit, will also provide Dr. Scott the right to terminate the Telepsychiatry session without refund.
2/ You may not record, through any means or medium (for example, video or audio), any segments or parts of the Telepsychiatry sessions without prior, written authorization from Dr Scott. Dr Scott also will not record, through any means or medium (for example, video or audio), any part of her Telepsychiatry sessions with you without obtaining prior written authorization from you.
3/ Payment
Dr Scott is an “out of network physician” with all insurance companies. She will give you a receipt for your expenses that you can submit to your insurance company for reimbursement. It is your responsibility to check with your insurance carrier to what extent do they reimburse Psychiatric/Telepsychiatry services.
You agree to pay the full amount of any missed appointments, unless you cancel or reschedule the appointment at least 24 hours in advance of your scheduled appointment.
4/ The Telepsychiatry form of psychiatric treatment is not suited for everyone and is not proper for all psychiatric conditions. If Dr Scott concludes, in her sole professional judgment, that your condition cannot be treated through the Telepsychiatry method, and that you may require another or different form of treatment, Dr. Scott will so advise you after the initial evaluation, and she will refer you to another provider.
If the termination of the therapeutic alliance becomes necessary at a later time during the treatment, Dr Scott will give you 3-month notice in advance in writing, and she will refer you to another provider in your area.
If you engage another psychiatric service provider, Dr. Scott will, upon your request and following your written authorization, communicate with that new provider regarding your therapy.
Termination of Telepsychiatry treatment will not entitle you to any refund for services previously rendered by Dr. Scott.
5/ Phone calls:
Every effort will be made to return your non-emergency phone calls within 48 hours.
IN THE EVENT OF LIFE THREATENING EMERGENCIES, YOU MUST CONTACT EMERGENCY RESPONDERS BY CALLING 911 OR GO TO THE NEAREST HOSPITAL EMERGENCY ROOM. DR. SCOTT CANNOT PROVIDE EMERGENCY TREATMENT.
6/ E-mail use:
Dr Scott does not correspond on clinical matters by E-mail.
E-mail use is limited to requests for medication refills by already established patients.
Dr Scott is not responsible for the safety and confidentiality of information related to her via E-mail. Do not use E-mail for any matter that cannot wait at least 72 hours to be addressed.
7/ Medications
It is your responsibility to inform all of your doctors about ALL the medications that you are taking, and about your medical and psychiatric conditions.
8/ You must be a resident of New York or New Jersey to receive services from Dr Scott. By accepting the terms and conditions of this agreement you affirm that you reside in one of these states, and you are at least 18 years old.
9/ Users of this website accept full responsibility for the use of information from this site and any sites linked to or from it. Dr Scott does not make any representations to its completeness or appropriateness for a particular purpose. Dr Scott is neither responsible nor liable for any claim, loss or damage resulting from use of information on this site. The mention of a specific product or service does not constitute a recommendation unless so stated.
The content of this website, and any services contained therein, is not intended to, and does not, provide medical advice, diagnosis, or treatment. Communication with Dr Scott through the website does not establish a physician-patient relationship.
10/ By clicking on the box below labeled "I have read the terms and conditions of treatment and consent to them" you consent to a psychiatric evaluation and treatment by Dr Scott using the Telepsychiatry method, as it is explained under “How it works”. You have the right to revoke this consent at any time by providing Dr. Scott with a statement of such revocation in writing. If you revoke your consent, no further services will be provided by Dr. Scott nor will you be able to schedule further appointments with Dr. Scott.
11) The terms and conditions of this notice may change at any time without prior notice, please read and review it carefully every time before you schedule an appointment.
