Palm Tree Psychiatry PLLC | SimplePractice

Client Preferences

Is there anything that the practitioner needs to know?

For example: what you'd like to focus on, insurance or payment questions, etc.

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Billing & Payment

Dr. Tzvi Furer and Palm Tree Psychiatry PLLC does not participate in insurance plans. I understand I am responsible for payment in full at the time service is rendered, unless other arrangements have been made. If necessary, a superbill will be provided that can be submitted for possible out of network reimbursement. Palm Tree Psychiatry is not responsible for whether a health insurance plan reimburses treatment costs, and does not participate in negotiation with insurance companies.

I agree and understand that Dr. Furer & Palm Tree Psychiatry does not participate in any insurance plans.

I have reviewed and are aware of the fees for service:

https://www.palmtreepsychiatry.com/fees

I am aware of the fees of the practice, and wish to proceed with scheduling a consultation.

Please be aware that initial consultations, even if completed, are not an indication or confirmation of continued treatment. If continued treatment with Dr. Furer / Palm Tree Psychiatry PLLC is not clinically indicated, our practice will work with you to offer alternative providers or recommendations for treatment.

I am aware and understand that initial consultations are not a guarantee of continued treatment or acceptance into the practice.

If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice.

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