Office Policies

Office Hours and Emergency Services

Our office is open Monday through Friday, 7:30 AM to 5:00 PM, and on Saturdays for medication management appointments with select prescribers. We are closed on Sundays and all major holidays. We do not provide emergency services, crisis services, or after-hours coverage.

In the event of a life-threatening emergency, please call 911 or go to your nearest emergency room. For urgent mental health crises outside office hours, contact the 988 Suicide & Crisis Lifeline or text HOME to 741741.

Appointment Scheduling

All appointments must be scheduled in advance. We send appointment reminders as a courtesy, but it is your responsibility to keep track of your scheduled appointments. You must confirm your appointment when prompted. Repeated no-shows may result in discharge from the practice.

Missed Appointment and No-Show Policy

We require advance notice for all appointment cancellations. Failure to provide adequate notice will result in a missed appointment fee that must be paid before scheduling future appointments. These fees are not billable to insurance.

• New Patient Medication Management: 1 business day advance notice required. No-show fee: $150.

• Established Patient Medication Management: 24 hours advance notice (1 business day) required. No-show fee: $100.

• TMS and IOP/PHP Appointments: 24 hours advance notice (1 business day) required. No-show fee: $100.

• Therapy Appointments: 24 hours advance notice (1 business day) required. No-show fee: $100.

Medication Prescription and Refill Policy

Medication refills require a scheduled appointment (virtual or in-person). Please schedule your follow-up appointments in advance to ensure you do not run out of medication. We do not provide emergency refills or bridge prescriptions.

• Request refills during your scheduled appointment only.

• Allow 24–48 hours for processing of routine prescriptions.

• Schedule 2 medications require electronic prescribing to your pharmacy.

• It is your responsibility to verify that prescribed medications are covered by your insurance formulary.

For patients prescribed controlled substances, please review our Controlled Substance Policy tab.

Financial Policies

You are responsible for all charges related to your care, regardless of insurance coverage. Insurance verification is not a guarantee of payment.

• We require a credit card on file for all patients.

• We accept credit cards, debit cards, and HSA/FSA cards.

• Copays and deductibles are due at time of service.

• There is a $15 fee for any payments disputed through the bank

• There is a $50 charge for any returned checks

Administrative Fees:

• Paperwork and forms: $30–$150 depending on complexity

• Letters for work/school: $30

Insurance

Medical expenses are the patient's responsibility regardless of insurance coverage. While we verify your benefits with your insurance company as a courtesy, a copay or coinsurance estimate provided by us, is not a guarantee of insurance coverage or payment. Patients are responsible for knowing the stipulations of their insurance policy. If for some reason your insurance company fails to pay for services rendered and/or you are not eligible at the time the services are rendered, the patient is responsible for payment. You also agree to take full responsibility for the entire amount due for any and all services rendered that are not covered by your insurance carrier. You are responsible to timely notify our office for any changes of insurance or demographics information. You authorize your insurance plans to pay directly to Allen Psychiatry for the services provided.

Medical Records

If you need a copy of your medical records, please contact our office for access. If medical records are being requested to be sent to another entity, a release authorization form must be signed and an 8-10 business day turnaround time can be expected.

Communication Policy

By providing your contact information, you consent to receive communications from our office via phone, email, and text message. These may include appointment reminders, billing information, and prescription notifications. Email and text messaging are not secure forms of communication.

Scope of Services

We provide outpatient psychiatric and mental health services including psychiatric evaluations, medication management, psychotherapy, TMS therapy, and IOP/PHP services.

We do not provide: emergency or crisis services, forensic evaluations, custody evaluations, disability determinations, accommodations, court testimony, fitness for duty, occupational psychiatry or legal reports.

Confidentiality and Mandated Reporting

Your treatment information is confidential and will not be released without your written consent, except as required by law. We are mandated reporters and must report suspected child abuse, elder abuse, or threats of harm to self or others.

Privacy Policy & Terms of Use

Last Updated: November 2, 2026

Welcome to Allen Psychiatry. This Privacy Policy and Terms of Use describes what information we collect, how we use and protect it, how our website uses cookies and analytics, and the terms governing your use of our website and services. How we use and disclose your health information as a patient is described in our HIPAA Notice of Privacy Practices.

Emergency Services Disclaimer

Allen Psychiatry does not provide emergency or crisis services.

If you are experiencing a medical or psychiatric emergency, including thoughts of harming yourself or others:

• Call 911 or go to your nearest emergency room
• Call 988 (Suicide & Crisis Lifeline) for 24/7 support
• Text "HELLO" to 741741 (Crisis Text Line)

Do not use our website, patient portal, or voicemail for emergencies. These are not monitored 24/7.

Information We Collect

Information you give us. When you contact us, request an appointment, apply for a job, refer a patient, or become a patient, we collect the information you provide, such as your name, date of birth, address, phone number, email address, insurance information, appointment details, and what you write in our forms or tell us.

Health information. As a patient, we collect the medical and mental health information needed to provide your care, including your history, treatment records, and billing information. Please do not include medical details in our website contact forms; we will discuss anything clinical with you directly.

Information from others. We may receive information about you from other healthcare providers who refer you to us, from your insurance company, and from family members or others you authorize.

Website technical information. When you visit our website, our hosting provider receives the standard technical information every website receives, such as your IP address and your browser and device type, to deliver pages and protect the site. If you accept analytics cookies, we also collect the information described in "Cookies and Website Analytics" below.

How We Use Your Information

• Provide mental health treatment and services
• Schedule appointments and contact you by phone, text message, or email about your appointments and care, using the contact methods you choose
• Respond to your questions and requests
• Process payments and insurance claims
• Understand how our website is used and which of our advertising brings people to us, if you accept analytics cookies
• Protect our patients, staff, website, and practice, and prevent spam and abuse
• Comply with legal and regulatory requirements, including responding to court orders and subpoenas

We do not sell your personal information, and we do not share it for targeted advertising.

Cookies and Website Analytics

We ask first. When you first visit our website, we ask whether you accept analytics cookies. If you choose Reject, or make no choice, Google Analytics is not loaded and nothing is sent to it. If your browser sends a Global Privacy Control signal, we treat that as Reject. You can change your choice at any time with the "Cookie Settings" link at the bottom of every page.

If you choose Accept, we use Google Analytics, a service of Google LLC, which sets cookies in your browser and receives:

• a randomly generated identifier for your browser;
• general information about your device and browser, and the approximate location Google derives from your IP address;
• which general parts of our website you visit. Before anything is sent, we remove the names of conditions, treatments, clinicians, articles, and support groups from page addresses and page titles (for example, a condition page is reported only as "/conditions/[redacted]");
• that you clicked to call us, opened our online booking, or sent our contact form, reported without the page you were on and without anything you typed.

Advertising measurement. If you reached our website by clicking one of our Google ads, Google adds an ad-click identifier to the link. If you accept analytics cookies, we keep that identifier so we can learn which of our ads lead people to contact us. Google already knows which ad was clicked; we do not send Google anything about the conditions or treatments you read about.

What we do not do. We do not place the Google Ads tag on our website, and we do not use remarketing, interest-based advertising, or Google signals. We do not use advertising or tracking pixels from other companies. We never send your name, contact details, or what you type in our forms to Google Analytics.

Our own cookie. We store your Accept or Reject choice in a cookie on our own website (named "ap_consent") for about six months, so we don't have to ask on every visit.

Other Services on Our Website

• Hosting and data storage: our website and the forms you submit are hosted and stored with Google Cloud (Firebase), and our staff are notified of new submissions by email.
• Spam protection: our website uses Google reCAPTCHA (for example, on our provider referral form), which receives information about your browser and how you use the page to tell people from automated programs.
• Map: our Contact page shows an embedded Google Map, which loads directly from Google. Google receives your IP address and the name of our website, but not the page address.
• Online booking: "Book Appointment" opens a separate scheduling application operated for us by a service provider.
• Telehealth: virtual visits use Doxy.me, a HIPAA-compliant telehealth platform.

Sharing Your Information

We share personal information only with service providers that help us operate our practice and website, such as those described above, and when required or permitted by law. Health information is used and disclosed as described in our HIPAA Notice of Privacy Practices.

Our website may link to other websites, such as our social media pages. We are not responsible for the content or privacy practices of those websites, and we encourage you to read their privacy policies.

Security

We use physical, electronic, and administrative safeguards designed to protect your information from unauthorized access, disclosure, alteration, and loss. If a breach affects your information, we will notify you as required by law. If you believe your information has been compromised, please contact us right away.

Your Rights Under HIPAA

You have the right to:

• Access and obtain copies of your medical records
• Request corrections to your health information
• Receive confidential communications
• Request restrictions on certain uses of your information
• Receive notice of how your information is used

Website Terms of Use

By accessing this website, you agree to:

• Use the site only for lawful purposes
• Not copy, reproduce, or distribute content without permission
• Not attempt unauthorized access to any part of the site

All content on this website is property of Allen Psychiatry and protected by copyright law.

Medical Disclaimer

The information on this website is provided for general educational purposes only and is not intended as medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified mental health provider with any questions you may have.

Limitation of Liability

• Mental health treatment outcomes vary; we cannot guarantee specific results
• Allen Psychiatry is not liable for indirect or consequential damages
• We are not responsible for technical issues affecting website access

Governing Law

These terms are governed by the laws of the State of Texas. Any disputes shall be resolved in the courts of Collin County, Texas.

Changes to This Policy

We may update this Privacy Policy. Changes are posted on this page with a new "Last Updated" date and take effect when posted.

Contact Us

If you have questions about this Privacy Policy, please contact us:

Allen Psychiatry
1772 W. McDermott Dr
Allen, TX 75013
Phone: (469) 340-2777
Fax: (469) 925-2856
Email: office@allenpsychiatry.com

HIPAA Notice of Privacy Practices

IF YOU HAVE ANY QUESTION AND / OR CONCERNS REGARDING ETHICAL ISSUES, THEY MAY BE DIRECTED TO THE FOLLOWING CONSUMER HOTLINE AT 1-800-942-5540.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health services. 

Uses and Disclosures of Protected Health Information

Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician’s practice, and any other use required by law. 

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure the physician has the necessary information to diagnose or treat you. 

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission. 

Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of your physician’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities. For example, we may disclose your protected health information to medical students that see patients at our office. In addition we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment. 

We may use or disclose your protected health information in the following situations without your authorization. These situations include: as Required By Law, Public Health issues as required by law, Communicable Diseases: Health Oversight: Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation: Research: Criminal Activity: Military Activity and National Security: Worker’s Compensation: Inmates: Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the regulations of Section 164.500. 

Other Permitted and Required Uses and Disclosures will be made only with your consent, authorization or opportunity to object unless required by law. 

You may revoke this authorization, at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization. 

Your Rights

Following is a statement of your rights with respect to your protected health information:

Right to Inspect and Copy: You have the right to inspect and copy your protected health information. Under Federal law, however, you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of or for use in a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.

Right to Request Restrictions: You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purpose of treatment, payment, or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

Your physician is not required to agree to a restriction that you may request. If your physician believes that it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to use another Healthcare Professional.

Right to Restrict Disclosures for Services Paid Out-of-Pocket: Under the HITECH Act, if you pay for a service or health care item out-of-pocket in full, you have the right to ask us not to share that information for the purpose of payment or our operations with your health insurer. We will honor that request unless a law requires us to share that information.

Right to Request Confidential Communications: You have the right to request to receive confidential communication from us by alternative means or at an alternative location.

Right to Amend: You may have the right to have your physician amend your protected health information. If we deny your request for amendment, you have the right to file a statement of disagreement with us.

Right to an Accounting of Disclosures: You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.

Right to a Paper Copy: You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.

Breach Notification

We are required by law to notify you if there is a breach of your unsecured protected health information. We will notify you of any such breach as required by law.

Changes to This Notice

We reserve the right to change the terms of this notice and will inform you of any changes. You then have the right to object or withdraw as provided in this notice.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.

Privacy Officer

Allen Psychiatry & Mental Health
1772 W. McDermott Dr
Allen, TX 75013
Phone: (469) 340-2777
Email: office@allenpsychiatry.com

U.S. Department of Health and Human Services

Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/ocr

Texas HB 300 Electronic PHI Disclosure Notice

In accordance with Texas Health & Safety Code Chapter 181 (HB 300), Allen Psychiatry may disclose your Protected Health Information (PHI) electronically for purposes of treatment, payment, and healthcare operations. You have the right to request restrictions on electronic disclosures. For questions, contact our Privacy Officer at office@allenpsychiatry.com or (469) 340-2777.

What is Texas HB 300?

Texas House Bill 300, codified in the Texas Health & Safety Code Chapter 181, establishes enhanced privacy protections for individuals' health information beyond what is required by federal HIPAA regulations. It governs how covered entities in Texas may collect, use, and disclose protected health information, with specific provisions for electronic disclosures.

Your Rights Under HB 300

As a patient of Allen Psychiatry, you have the following rights under Texas HB 300:

• Right to Request Restrictions: You may request that we restrict electronic disclosures of your PHI. We will consider your request, though we are not required to agree to all restrictions.
• Right to Receive an Accounting: You may request an accounting of electronic disclosures of your PHI that we have made for purposes other than treatment, payment, or healthcare operations.
• Right to Access: You have the right to access your electronic health records and to request copies in electronic format.
• Right to be Notified: You have the right to receive notification if there is an unauthorized acquisition, access, use, or disclosure of your PHI.
• Right to File a Complaint: If you believe your rights under HB 300 have been violated, you may file a complaint with our Privacy Officer or with the Texas Attorney General's office.

How We Protect Your Electronic PHI

Allen Psychiatry employs the following safeguards to protect your electronic health information:

• Encryption: All electronic PHI is encrypted during transmission and storage
• Access Controls: Electronic health records are accessible only to authorized personnel involved in your care
• Audit Trails: We maintain audit logs of all access to electronic health records
• Staff Training: All employees receive training on HB 300 compliance and electronic PHI handling procedures
• Business Associate Agreements: We require all third-party vendors who handle electronic PHI to sign agreements ensuring compliance with Texas and federal privacy laws

Electronic Disclosures We May Make

We may electronically disclose your PHI for the following purposes:

• Treatment: Sharing records with other healthcare providers involved in your care via secure electronic health record systems
• Payment: Submitting electronic claims to your insurance company for reimbursement
• Healthcare Operations: Quality improvement activities, credentialing, and other operational purposes
• As Required by Law: When required by Texas or federal law, court order, or subpoena

How to Exercise Your Rights

To request restrictions on electronic disclosures, request an accounting of disclosures, or exercise any other rights under HB 300, please contact our Privacy Officer:

Privacy Officer

Allen Psychiatry & Mental Health
1772 W. McDermott Dr
Allen, TX 75013
Phone: (469) 340-2777
Fax: (469) 925-2856
Email: office@allenpsychiatry.com

Texas Attorney General

Office of the Attorney General
P.O. Box 12548
Austin, TX 78711-2548
Phone: (800) 252-8011
Website: www.texasattorneygeneral.gov

This notice is provided in accordance with Texas Health & Safety Code Chapter 181 (HB 300). For additional privacy information, please review our HIPAA Notice of Privacy Practices.

Terms of Service

These Terms of Service govern your use of mental health services provided by Allen Psychiatry. By receiving services from our practice, you agree to these terms and our policies.

Limitation of Liability

• Mental health treatment outcomes vary; we cannot guarantee specific results

• Allen Psychiatry is not liable for indirect or consequential damages

• We are not responsible for technical issues affecting website access

Services Provided

Allen Psychiatry provides outpatient mental health services including psychiatric evaluation, medication management, psychotherapy, TMS therapy, Spravato treatment, and intensive outpatient programs. Services are provided by licensed healthcare professionals.

Patient Responsibilities

Patients are responsible for providing accurate health information, attending scheduled appointments, following treatment recommendations, and promptly paying for services. Patients must notify us of appointment cancellations at least 24 hours in advance.

Payment Terms

Payment is due at the time of service unless other arrangements have been made. We accept insurance, credit cards, and cash. Patients are responsible for copayments, deductibles, and any services not covered by insurance.

Limitations of Services

Our services are limited to outpatient mental health treatment. We do not provide emergency services. In case of a medical or psychiatric emergency, please call 911 or go to your nearest emergency room.

Medical Disclaimer

The information on this website is provided for general educational purposes only and is not intended as medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified mental health provider with any questions you may have.

Allen Psychiatry does not provide emergency or crisis services.

If you are experiencing a medical or psychiatric emergency, including thoughts of harming yourself or others:

• Call 911 or go to your nearest emergency room

• Call 988 (Suicide & Crisis Lifeline) for 24/7 support

• Text "HELLO" to 741741 (Crisis Text Line)

Do not use our website, patient portal, or voicemail for emergencies. These are not monitored 24/7.

Governing Law

These terms are governed by the laws of the State of Texas. Any disputes shall be resolved in the courts of Collin County, Texas.

Contact Us

If you have questions about these terms, please contact us:

Allen Psychiatry
1772 W. McDermott Dr
Allen, TX 75013
Phone: (469) 340-2777
Email: office@allenpsychiatry.com

Your rights as a patient are important to know. Allen Psychiatry respects each patient and their rights. Allen Psychiatry will provide you with a humane environment that provides reasonable protection from harm and appropriate privacy for your personal needs.

The facility shall respect, protect, implement and enforce each client right required to be contained in the facility's Client Bill of Rights.

Your Rights

1. You have the right to accept or refuse treatment after receiving this explanation.
2. If you agree to treatment or medication, you have the right to change your mind at any time (unless specifically restricted by law).
3. You have the right to a humane environment that provides reasonable protection from harm and appropriate privacy for your personal needs.
4. You have the right to be free from abuse, neglect, and exploitation.
5. You have the right to be treated with dignity and respect.
6. You have the right to appropriate treatment in the least restrictive setting available that meets your needs.
7. You have the right to be told about the program's rules and regulations before you are admitted, including, without limitation, the rules and policies related to restraints and seclusion. Your legally authorized representative, if any, also has the right to be and shall be notified of the rules and policies related to restraints and seclusion.
8. You have the right to be told before admission:
   • The condition to be treated;
   • The proposed treatment;
   • The risks, benefits, and side effects of all proposed treatment and medication;
   • The probable health and mental health consequences of refusing treatment;
   • Other treatments that are available and which ones, if any, might be appropriate for you; and
   • The expected length of stay.
9. You have the right to a treatment plan designed to meet your needs, and you have the right to take part in developing that plan.
10. You have the right to meet with staff to review and update the plan on a regular basis.
11. You have the right to refuse to take part in research without affecting your regular care.
12. You have the right not to receive unnecessary or excessive medication.
13. You have the right to have information about you kept private and to be told about the times when the information can be released without your permission.
14. You have the right to be told in advance of all estimated charges and any limitations on the length of services of which the facility is aware.
15. You have the right to receive an explanation of your treatment or your rights if you have questions while you are in treatment.
16. You have the right to make a complaint and receive a fair response from the facility within a reasonable amount of time.
17. You have the right to complain directly to the Texas Health and Human Services Commission at any reasonable time.
18. You have the right to get a copy of these rights before you are admitted, including the address and phone number of the Texas Health and Human Services Commission (HHSC).
    
    Texas Health and Human Services Commission
    Complaint Hotline: 1-800-942-5540
    Address: 1100 West 49th Street, Austin, Texas 78756
    Phone: 512-776-7111
19. You have the right to have your rights explained to you in simple terms, in a way you can understand, within 24 hours of being admitted.

Quality and Safety Concerns

Allen Psychiatry is accredited by The Joint Commission. You may also report quality or safety concerns to:

Protected by Texas Health and Safety Code Chapter 464 and 25 TAC §448.703.

Controlled Substance Policy Agreement

Please carefully read and review this Controlled Substance Policy Agreement. If you agree to the terms, please sign the last page of this agreement which will become part of your patient record.

If you do not agree with these terms, you will not be able to establish care or continue your services with Allen Psychiatry.

• Safe Storage: It is my responsibility to keep my medications in a safe, locked place. If a controlled substance prescription or medication is damaged, misplaced, stolen, or if I run out of it sooner than prescribed, I understand that it will not be replaced.

• New Patient Evaluations: A new patient evaluation does not guarantee a patient/provider relationship. Scheduling an appointment with our office does not guarantee continuance of previously prescribed prescriptions and your treatment plan will be developed based on the expertise of our providers in conjunction with state and federal law.

• Prior Records Required: If you have a previous psychiatrist prescribing you controlled substances, you must sign a Release of Information form. We need the medical records from your previous psychiatrist for a smooth transition of care.

• Mandatory Lab Work: I understand that it is mandatory to complete labs like a urine drug screen and CMP blood test before I can be prescribed any controlled substances or at any time during my treatment, at the discretion of my provider. It is my responsibility to complete all lab work as ordered by my provider in a timely manner. I also understand that my provider can withhold my prescription in absence of mandatory lab work.

• Single Provider Requirement: While I am receiving controlled substance medications from Allen Psychiatry, I will not request, nor accept the same controlled substance medications from any other physician, or individual. I understand that it is illegal to do so, and may also endanger my health. The only exception is if it is prescribed while I am admitted in hospital or previously discussed with my physician/provider.

• Refill Policy: Refills of controlled substance medications will only be issued during regular office hours while I am present for an office visit (in person or virtual). Refill requests will not be responded to at night, on holidays, or on weekends.

• Regular Follow-Up Appointments: I understand I may be required to see my provider at regular intervals — every month, every 2 months, or every 3 months, based on the clinical judgment of my provider. I understand that my prescription will not be filled if I do not schedule my follow-up appointment or do not show up for my appointment. It is required by the DEA that I have at least one in-person visit with a provider at this practice to continue receiving my controlled substance prescription.

• Medication Tracking: I will keep track of my medications and call at least 48 hours in advance if I need assistance with a prescription. I will not take more medication than prescribed — this means I should never "run out early."

• Withdrawal Risks: If I overuse my medication and do not have my regularly prescribed dose and schedule, I will go through withdrawal. Withdrawals are severe and potentially fatal, caused by cessation of a controlled substance. Symptoms can include severe tremors, confusion, or seizures. If this happens, I have been instructed to seek emergency help immediately.

• Inpatient Detox: My psychiatrist can recommend inpatient detox in case of me running out of my medications as a result of overuse or overdose.

• Prohibited Substances: I will not take any "street drugs" including marijuana, Delta 8, and other THC products. I also understand that my psychiatrist can restrict the use of any substance like marijuana and alcohol which may be legal but cannot be used in combination with certain medications.

• Medication Changes: I understand that taking any non-prescribed drugs or changing/stopping medications without discussing with my physician may result in discharge from Allen Psychiatry or reevaluation of my current treatment.

• Treatment Compliance: I understand the importance of following my treatment plan as directed by my physician and agree:

  • To attend all scheduled appointments (follow-up and/or referrals), AND

  • To permit urine drug screening at the discretion and instruction of my provider at any time.

• Policy Violations: I understand that if I violate any of the above conditions, my controlled substance prescriptions and/or treatments at Allen Psychiatry may be ended immediately. If the violation involves obtaining controlled substances from another individual, as described above, I may also be reported to my primary physician, local medical facilities, and other state and federal authorities such as the DEA. I understand that it is a crime to give or sell your controlled prescriptions to anyone else.

• Habit-Forming Medications: I have been fully informed by my provider that controlled medications can be habit forming and I could potentially need higher doses to achieve the same result as time goes on. To stop medications, I must do so slowly, under medical supervision, or I may have withdrawal symptoms.

• Emergencies: If a patient or someone else takes more than the prescribed/recommended dosage of a medicine, call 911, contact poison control or go to your nearest emergency room immediately.

Good Faith Estimate & No Surprises Act

Effective Date: January 1, 2022 (federal No Surprises Act). Last reviewed: 2026.

Quick summary. If you don’t have health insurance, or you have insurance but choose not to use it, you have the right to receive a written Good Faith Estimate of what your visit will cost before you receive care. If you are billed at least $400 more than your estimate, you have the right to dispute the bill through a federal resolution process.

What is a Good Faith Estimate?

A Good Faith Estimate is a written summary of the expected charges for a scheduled medical service. Under the federal No Surprises Act (45 CFR §149.610), Allen Psychiatry & Mental Health is required to provide one to any patient who is uninsured or who is not planning to submit a claim through their insurance plan. The estimate is required for any non-emergency item or service we provide.

Who has the right to a Good Faith Estimate?

• Patients who do not have any form of health insurance (including Medicare, Medicaid, or commercial coverage).
• Patients who do have insurance but are choosing not to use it to pay for a specific service (also called “self-pay”).
• Anyone who requests an estimate before scheduling a service, even if they are not yet a patient.

What does the estimate include?

Your Good Faith Estimate will list, in writing, the expected charges for:

• The specific service or item you are scheduling (for example, an initial psychiatric evaluation, a follow-up medication-management visit, or a TMS treatment course).
• Any other items or services we reasonably expect to provide alongside the scheduled service in the same period of care.
• A diagnosis code (if known), service codes (CPT/HCPCS), and the expected cost for each line.

The estimate covers the items and services we provide directly. It does not cover unexpected costs that come from a different provider or facility, or from changes in your treatment plan that we cannot anticipate at the time the estimate is given.

When will I receive the estimate?

Timing is set by federal regulation:

• If you schedule a service at least 3 business days in advance, you will receive your Good Faith Estimate no later than 1 business day after scheduling.
• If you schedule a service at least 10 business days in advance, you will receive your estimate no later than 3 business days after scheduling.
• If you request an estimate without scheduling, you will receive it within 3 business days of your request.

How do I request a Good Faith Estimate?

You can request a Good Faith Estimate at any time, in any of the following ways:

• By phone: Call our billing team at (469) 340-2777 during regular business hours.
• By email: Email office@allenpsychiatry.com with “Good Faith Estimate Request” in the subject line and a description of the service you are considering.
• In person: Ask a member of our front-desk team at any of our offices.

You can request an estimate before you schedule, and you can also ask for an updated estimate if your treatment plan changes after the original estimate was issued.

Your right to dispute a bill

If you receive a final bill from Allen Psychiatry & Mental Health that is at least $400 more than the Good Faith Estimate, you have the right to dispute the bill through the federal Patient-Provider Dispute Resolution (PPDR) process. Key points to know:

• You must start a dispute within 120 calendar days of receiving the bill.
• An independent third party will review the bill and the estimate, and will determine an appropriate payment amount.
• There is a small administrative fee to start a dispute (refundable if you prevail). Disputing a bill will not affect your right to continued care at our practice.
• To start a dispute or learn more, visit www.cms.gov/nosurprises or call 1-800-985-3059.

Save your estimate

Please keep a copy of your Good Faith Estimate. You will need it if you decide to dispute a bill later. If you lose your copy, contact our billing team and we will send you another.

This notice is not a contract

A Good Faith Estimate is an estimate, not a guaranteed price. The actual charges for your care may be higher or lower depending on your specific clinical situation, your treatment plan, and any unexpected items or services that arise during care. We will discuss any meaningful changes with you before they happen, and we will provide an updated estimate when appropriate.

Questions or more information

For questions about your right to a Good Faith Estimate, please contact:

Allen Psychiatry & Mental Health — Billing

1772 W. McDermott Dr
Allen, TX 75013
Phone: (469) 340-2777
Fax: (469) 925-2856
Email: office@allenpsychiatry.com

Centers for Medicare & Medicaid Services (CMS)

Phone: 1-800-985-3059
Website: www.cms.gov/nosurprises

This notice is provided in accordance with the federal No Surprises Act (45 CFR §149.610) and is intended to inform uninsured and self-pay patients of their right to a Good Faith Estimate of expected charges. It does not replace any rights you may have under your insurance plan or state law.