Practice Policies


APPOINTMENTS AND CANCELLATIONS Please remember to cancel or reschedule 24 hours in advance.

The standard meeting time for Telemedicine is 15 minutes.

To schedule an appointment, a $50.00 reservation fee is necessary. This fee must be paid in advance to secure the appointment slot and will be applied as a credit against the fee for your initial consultation, amounting to $499.

TELEPHONE ACCESSIBILITY If you need to contact me between sessions, please leave a message on my voicemail. I am often not immediately available; however, I will attempt to return your call within 24 hours. If a true emergency situation arises, please call 911 or any local emergency room.

SOCIAL MEDIA AND TELECOMMUNICATION Due to the importance of your confidentiality and the importance of minimizing dual relationships, I do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc). I believe that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when we meet and we can talk more about it.

ELECTRONIC COMMUNICATION I cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, I will do so. While I may try to return messages in a timely manner, I cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies. Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail is considered telemedicine by the State of California. Under the California Telemedicine Act of 1996, telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another. If you and your health care provider chose to use information technology for some or all of your treatment, you need to understand that:

  1. You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled.
  2. All existing confidentiality protections are equally applicable.
  3. Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee.
  4. Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent.
  5. There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to treatment, better continuity of care, and reduction of lost work time and travel costs. Effective treatment is often facilitated when the healthcare provider gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client. The provider may make assessments, diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third-person consultations, but also from direct visual and olfactory observations, information, and experiences. When using information technology in services, potential risks include, but are not limited to the provider’s inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: your physical condition including deformities, apparent height and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression. Potential consequences thus include the provider not being aware of what he or she would consider important information, that you may not recognize as significant to present verbally to the provider.

TERMINATION Ending relationships can be difficult. The criteria for terminating a physician-patient relationship are numerous and varied. Although the list is not exhaustive, it is appropriate and acceptable to terminate a relationship under the following circumstances:

  • Treatment nonadherence—The patient does not or will not follow the treatment plan.
  • Follow-up nonadherence—The patient repeatedly cancels follow-up visits or is a no-show.
  • Office policy nonadherence—The patient fails to follow office policies, such as those for payment, prescription refills, or appointments. For example, the patient uses weekend on-call physicians or multiple healthcare practitioners to obtain refill prescriptions when office policy specifies how to obtain refills between visits.
  • Verbal abuse—The patient or a family member is rude and uses improper language with office personnel or other patients, visitors, or vendors; exhibits violent behavior; makes threats of physical harm; or uses anger to jeopardize the safety and well-being of anyone present in the office.
  • Nonpayment—The patient owes a backlog of bills and has declined to work with the office to establish a payment plan.Upon termination, a written notice will be provided that you must find another healthcare practitioner. The written notice will be mailed to you by both regular mail and certified mail with a return receipt requested. Reasons for termination may include “inability to achieve or maintain rapport” or that “the therapeutic practitioner-patient relationship no longer exists” among others. The effective date of termination should provide you with a reasonable amount of time to establish a relationship with another practitioner in this case 30 days from the date of the letter. The relationship may be terminated immediately under the following circumstances:
    • You terminated the relationship.
    • You or a family member has threatened the practitioner or staff with violence or has exhibited threatening behavior.
  • Interim care provisions include emergency care. In the case of true emergency situations, you should go to an emergency department or call 911 as necessary.
  • Continued care provisions—You can call the referral line at the hospital for referral suggestions for continued care.
  • Request for medical record copies—Please return the enclosed authorization document (to be returned to the office with your signature) to copy and forward your medical record to a doctor of your choice.
  • Patient responsibility—You are responsible for all follow-up and continued medical care.
  • Medication refills—Medications will be provided only up to the effective date of termination.
  • If treatment is terminated for any reason or you request another provider, I will provide you with a list of qualified rheumatologists to treat you. You may also choose someone on your own or from another referral source.
  • Should you fail to schedule an appointment for four consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, I must consider the professional relationship discontinued.