• Patients are responsible for all medical charges regardless of insurance.

• Benefit verification and copay/coinsurance estimates are provided as a courtesy and are not guarantees of payment.

• If insurance denies payment or you are ineligible at time of service, you must pay the balance.

• You must inform the office of any insurance or demographic changes (especially each year).

• You must authorize your insurance to pay Mindful Care, PLLC directly for services.

• You are responsible for completing the Credit Card form for financial responsibility, even if you are on Medicare/Medicaid.

We accept most insurance including Medicare and Medicaid

• Mindful Care, PLLC does not provide forensic or occupational psychiatry and will not handle worker’s comp, divorce/child custody, fit-for-duty, disability evaluations, or other legal matters (including testimony or civil reports).

• Disability requests will not be processed.

• Paperwork requires prepayment and may take 5–10 business days.

• FMLA forms: $100 fee.

• Other letters/forms (school, work, emotional support pet, etc.) incur a minimum $20 fee and completion is at the provider’s discretion.

• Appointments are reserved time; please be on time (an appointment is a no-show after 10 minutes).

• Cancel or reschedule by phone to reception: 641-548-7177.

• Cancellations or no-shows without 24 business-hour notice incur fees: $40 for follow-up, $80 for initial.

• Missed appointments cannot be billed to insurance; you are responsible for the fee.

• After 3 missed (no-call/no-show) appointments you will be discharged.

• Missed-appointment fees will be billed to your account and charged to the provided payment method.

We use phone, email, and text for scheduling, billing, refills, and other service-related communication. While we secure our communications, you’re responsible for protecting your own devices and accounts. If you’re not comfortable with electronic communication or cannot keep it secure, you should not schedule an appointment.

Clinical Appointments are essential for addressing new symptoms or events. Please contact the office to schedule an appointment.

In the event that your provider, in her clinical judgment believes you to be dangerous to yourself or to someone else, by signing this consent you authorize her to contact either the person listed as your emergency contact or someone else to aid through a crisis situation.

• If a copy of your medical records are needed, our office needs a signed notification from the patient and 2 weeks notice. The charge for medical records is $20. There is no fee for office to office records requests.

Lab tests may sometimes be required and are not included in visit fees. You are responsible for checking costs with the lab. You may choose any lab you prefer. If you’re prescribed controlled medications, drug screenings may be required. Any ordered labs must be completed within 36 hours.

If a conflict arises for the client or the provider, either has the right to withdraw from the treatment. If the provider feels the need to withdraw from providing treatment, she will inform client and will try to provide appropriate referrals and a 30-day (non-controlled) prescription.

There is a $50 charge for any returned checks.