ERIC YARBROUGH, MD - PATIENT TREATMENT AGREEMENT
Please review this agreement carefully, as it outlines important information regarding treatment,
communication, scheduling, billing, and office policies.
Insurance, Billing, Scheduling, & Communication
• Insurance claims are processed through Headway.
• If you are using insurance, you will receive separate forms and communications from
Headway regarding benefits, billing, and insurance coverage.
• Any questions regarding insurance claims, copays, deductibles, or billing should be directed
to Headway.
• I use SimplePractice for scheduling, clinical documentation, prescriptions, and patient
communication. You may be asked to provide information in both Headway and
SimplePractice, even if it appears redundant. This is necessary for proper recordkeeping and
insurance processing.
Email is the preferred method of communication for scheduling and administrative matters.
Office Hours: Monday through Thursday 2:00 PM – 8:00 PM
Office Address: 280 Meeker Avenue, Brooklyn, NY 11211
Detailed instructions for accessing the office will be provided prior to your appointment.
Professional Fees
Patients using insurance will be billed according to their insurance benefits through Headway.
Self-pay fees are as follows:
Initial Psychiatric Evaluation with first appointment (60 minutes): $600
Follow-Up Medication Management (25 minutes): $400
Individual Psychotherapy (45 minutes): $450
Payment
All payments are made by credit card and are processed following each appointment. Monthly
invoices are available upon request.
Cancellation & No-Show Policy
• Appointments must be canceled with at least 72 business hours' notice.
• Appointments canceled with less than 72 business hours' notice, as well as missed
appointments, will be charged the full appointment fee.
• Patients using insurance will be charged a flat $220 no-show fee for missed appointments or
late cancellations.
• Insurance companies do not cover missed appointment fees.Frequency of Treatment
Appointment frequency is determined by clinical need and will be discussed
New patients are generally seen at least monthly during the first six months of treatment and at
least quarterly thereafter. More frequent visits may be required depending on diagnosis,
treatment goals, and prescribed medications.
Emergencies & After-Hours Care
• Psychiatric emergencies should be addressed by calling 911 or proceeding to the nearest
emergency room.
• If emergency treatment is required, please provide treating clinicians with my contact
information. I will make every reasonable effort to coordinate care.
• Messages received during business hours are generally returned within 24–72 hours,
excluding vacations and holidays.
• If you require an urgent appointment and no openings are available, please email me with
your availability, and I will make every effort to accommodate you.
Email & Communication Guidelines
• Email should be used only for administrative matters such as scheduling appointments,
updating contact information, or other logistical questions.
• Clinical matters, including medication effectiveness, side effects, treatment
recommendations, medication change requests, and prescription refill requests, should be
addressed during scheduled appointments.
• Email is not continuously monitored and should never be used in emergencies.
Medication Policies
• Medication management is conducted during scheduled appointments. Patients are expected
to maintain regular follow-up appointments as recommended.
• Prescription refills are generally provided only during scheduled appointments. Requests for
refills between appointments may be denied if a follow-up appointment is overdue or if
additional clinical assessment is needed.
• Patients who repeatedly miss appointments or fail to attend recommended follow-up visits
may have their prescriptions discontinued and be discharged from the practice.
• Controlled substances require at least monthly follow-up appointments unless otherwise
specified.
• Controlled substance prescriptions will not be replaced, refilled early, or rewritten due to loss,
theft, travel, or misuse.
• Patients must never share prescribed medications with others.
• Urine toxicology screening may be required when clinically indicated.
Additional Professional Services
Services performed outside of scheduled appointments may be billed separately.
Examples include:
• Completion of disability, school, workplace, or administrative forms
• Written reports or treatment summaries• Extended telephone consultations
• Coordination of care with therapists, physicians, family members, or other involved parties
These services are billed at $150 per 15-minute increment, with a 15-minute minimum charge.
Any charge will be discussed with you prior to completing the services
Confidentiality & Professional Boundaries
• Your treatment is confidential and protected by applicable privacy laws.
• By participating in treatment, you authorize communication with your treating healthcare
providers when clinically appropriate to coordinate care. Whenever possible, I will inform
you before such communication occurs.
• Written authorization is required before I communicate with family members, partners, or
friends except in emergency situations or when otherwise permitted by law.
• To preserve professional boundaries and patient confidentiality, I do not engage with patients
through social media.
• If we encounter one another in a public setting, I cannot initiate contact or acknowledge you
out of respect for your privacy.
Termination of Treatment
• Either you or I may choose to end treatment at any time.
• If treatment is terminated, I will provide appropriate referrals and, when clinically
appropriate, a reasonable supply of medication to facilitate continuity of care.
• I reserve the right to discontinue treatment if I determine that continued treatment is not
clinically appropriate, if office policies are repeatedly violated, or if the therapeutic
relationship can no longer effectively support your care.