Patient Information
Download Patient Forms
To view the forms listed below, you will need to download Adobe Reader.
In order to make our initial consultation most effective and efficient, the forms to the right will be sent to you using the Luminello Patient portal. It is a HIPAA compliant method to deliver patient information securely.
- Please look for an email invitation from Luminello.
- Once an account with Luminello is created, you will be able to find the electronic version of all the needed documents, so you can fill them out and submit to our clinic’s review without the need to print, scan or use of special software.
Consultation appointments may be cancelled if the intake paperwork in its entirety is not submitted within 48 hours of an initial consultation without discussing it with the clinic in advance.
Please note that in addition to the initial New Patient paperwork, as stated above, you must review, and consent to the financial agreement and Credit Card Authorization forms.
The financial credit card authorization forms and payment information is sent from the following email address: noreply@messaging.squareup.com
- The subject line is “Contract #”…
- You can copy and search your mail for this address and/or subject. It may be in your junk mail.
Billing & Insurance
Friedman Psychiatry now accepts Blue Cross Blue Shield (with some exceptions).
Please note that we do not accept any other insurance (also known as out of network). However, a receipt that can be used by patients to submit for reimbursement to insurance companies will be available for patients to download directly from the Patient Portal. Applying for reimbursement is strictly between you and your insurance. Our office does not offer assistance with insurance billing or reimbursement. The best way to find out what level of reimbursement your insurance would provide is calling and asking about coverage/reimbursement for out of network Psychiatrist for medication management and/or psychotherapy.
Private Payments for Out of Network with Dr. Friedman
- 50 Minute Initial Consultation $450*
Current rate for initial consultation
- 45 Minute Follow Up $265
Current rate for follow up meeting
- 20 Minute Follow Up $150
Best for some patients who want strictly medication management with no formal time for Psychotherapy (either due to seeing another therapist already, or due to preference)
Private Payments for Out of Network with Physician Assistant Desai
- 50 Minute Initial Consultation $250*
Current rate for initial consultation
- 45 Minute Follow Up $200
Current rate for follow up meeting
- 20 Minute Follow Up $115
Best for some patients who want strictly medication management with no formal time for Psychotherapy (either due to seeing another therapist already, or due to preference)
Frequency of appointments will be determined collaboratively based on clinical need and patient preference (as long as it’s clinically appropriate).
*Some consultations may require an additional 20 to 45 minutes appointment for collateral information in order to consider the consultation as complete. This need will be considered case by case and discussed with you, the patient in detail. Regardless of clinical recommendation, no contact with any third party will be made without explicit signed “Releaser of Information” consent form by you. Your privacy is of utmost importance to us. It is also protected by HIPAA laws. Additional charge for this collateral interview will be according to the time used.
Missed appointments or cancellation within less than 24 hour notice are expected to be paid in full, and will be automatically charged to the credit card on file.
- If a time-conflict arises with a scheduled appointment that is reserved for you, please let us know as soon as possible to avoid charges per clinic cancellation policy (see attachments).
- Appointments may NOT be rescheduled or cancelled by email or text. They can only be rescheduled or cancelled by phone, or online using the patient portal calendar. Please note that doing so less than 24 hours in advance will result in charge for the rescheduled or cancelled appointment.