The standard meeting time for the initial visit is 60-90 minutes and follow up visits are 15-40 

Payment is due within 24 hours of your appointment. You may lose your appointment if payment is not 
received within 24 hours of your scheduled time.

Cancellations and re-scheduled visits will be subject to a full charge IF NOT RECEIVED AT LEAST 48 
HOURS IN ADVANCE. This is necessary because a time commitment is made to you and is held 
exclusively for you. If you are late for an appointment, you may lose some of the allotted time for 
that appointment. Your card will automatically be billed 24 hours prior to your appointment if 
payment is not received.


Please plan ahead and schedule an appointment prior to running out of medication.

Patients requesting an unscheduled medication refill before attending their next appointment, in 
the event of a patient cancellation, no show, or reschedule, will be charged $25 fee.

Please allot for a 48-hour time frame (days only) for all medication refills. Medication refills 
will not be addressed on Mondays, as I am not in the office regularly, and medication changes, 
refill requests, and questions concerning your medication will not be addressed on holidays, 
weekends, evenings, or outside of your clinician’s office hours.

Controlled substances will not be authorized to fill early.

Kayee Wilson, PMHNP-BC utilizes the CRISP Prescription Monitoring Guide regularly.
If a patient does not attend an appointment for a period of time in excess of seven months, the 
patient’s medications will not be refilled.

The patient may be scheduled as a new patient and complete a new intake form at the discretion of 
the, PMHNP-BC. • If a patient is terminated from Completely Centered Health, LLC, a 30-day supply 
of most medications will be granted; no changes to the current medication regimen will be made 
during this time.


If you are experiencing a psychological emergency, a life-threatening emergency and/or medication 
side effects causing shortness of breath, heart problem                                              
life threatening concerns, please
call 911 or go to your nearest emergency room.

Client Rights/Discharge Non-voluntary discharge from treatment: A client may be terminated via a 
non- voluntary discharge letter if:
(A) The client exhibits physical violence, physical or emotional intimidation, verbal abuse of any 
kind, and/or patients or families carry weapons or engage in illegal acts of any kind. Abusive 
messages/email or phone correspondence may also be grounds for non-voluntary discharge.
(B) The client refuses to comply with stipulated clinic rules, refuses to comply with treatment 
plans/recommendations, or does not make a payment and/or payments arrangement in a timely manner.


We require parental consent for all visits done through telemedicine. We require your parents to be 
present during a portion of the visit to ensure that they are consenting to treatment.

If you are a minor, your parents may be legally entitled to some information about your treatment. 
We will discuss with you and your parents what information is appropriate for them to receive and 
which issues are more appropriately kept confidential.


In the event, the client is a minor, and their legal guardians are in the process of separating, 
are separated, have divorced or where there is joint legal custody, both parents must consent to 
treatment. Completely Centered Health, LLC is not held liable or responsible for the consenting 
parent/guardian of a minor, NOT informing us of the agreed/legal parental regulations prior to 
treatment on behalf of the other parent/guardian, if they are not present. It will be assumed by 
Completed Centered Health, LLC that all parents/guardians involved are in agreement to receiving 
all recommended treatment.
Please request the additional paperwork regarding; guardian treatment consent to comply with the 
treatment policies.


If you need to contact Completely Centered Health, LLC between sessions, please call our main 
number or send us a message through the website. We are often not immediately available; however, 
We will attempt to return your call or message within 24 hours. Please note that Face-to-face video 
visits are highly preferable to phone visits. However, in the event that you are out of town, sick 
or need additional support, phone sessions are available. If a true emergency situation arises, 
please call 911 or go to your local emergency room.


We cannot ensure the confidentiality of any form of communication through electronic media, 
including, but not limited to, text messages, telephone communication, the Internet, facsimile 
machines, and e-mail. Telemedicine is broadly defined as the use of information technology to 
deliver medical services and information between two parties that are at different locations. The 
above electronic means of communication are considered telemedicine. Utilizing telemedicine 
services through (Completely Centered Health, LLC) is voluntary in nature and you need to 

1.    You have the right withhold or withdraw your consent for telemedicine services at any time. 
If this occurs, you need to understand that we cannot provide care for you any longer as 
(Completely Centered Health, LLC ) is strictly a telemedicine practice.
2.    We will protect your protected health information in the same fashion as a brick and mortar 
practice. You need to understand though that data breaches can happen, and we cannot assure your 
information is 100% protected.
3.    We will not use your protected health information for research purposes unless you give us 
consent to do so.
4.    There are potential benefits, risks and subsequent consequences of telemedicine. Potential  
benefits include, but are not limited to improved access to care, reducing costs, improving the 
quality of visits, and reduction of travel time associated with medical visits. The medical 
provider will make assessments, diagnoses, and treatment plans based off all the visual and 
auditory information provided during the video conference. You must understand that this is limited 
and posts potential risks including, but not limited to the provider’s inability to make complete 
diagnostic assessments that might require a physical exam and to see the patient in person. During 
an in-person encounter, a medical provider has the ability to see the entire patient including but 
not limited to their gait, smell, general appearance, and demeanor. Potential consequences thus 
include the provider not being aware of clinically significant information that you may not 
recognize as significant to present verbally to the provider.

Professional Forms/Letters: Fees start at $25, and payment is due prior to the initiation of the 
form(s). Forms can take up to 10 business days to complete from the date the request was received.
PMHNP-BC does not offer Social Security Disability Evaluations/Forms or long-term disability.
Medical Records: Records are provided at a rate of $0.50 per page and a standard $5-dollar 
processing fee or $10 processing fee if record exceeds 25 pages. Medical records can take up to 15 
business days to complete from the date the request is received.
All requests for copies of medical records must be completed via Completed Centered Health, LLC 
authorization to release and request PHI form in writing, dated, and signed. Postage fees will 
apply as applicable.
Disability forms will be performed when the patient is in the practice for 6 months.
We can terminate treatment with you at any time. We will not terminate the medical relationship 
with you without first discussing and exploring the reasons and purpose of terminating. If 
treatment is terminated for any reason, we will provide you with a list of qualified providers to 
continue your care. You may also choose someone on your own or from another referral source. Should 
you fail to not show up for your follow up appointments, not obtain lab work in a timely fashion or 
are non-compliant with treatment, unless other arrangements have been made in advance, for legal 
and ethical reasons, we must consider the professional relationship discontinued.