Office Policies & Patient Responsibilities

F 949-543-2361

Appointment Policies

  • Scheduling & Attendance:

    • Once you schedule an appointment, it is your responsibility to complete initial intake paperwork at least 24 hours in advance and attend appointments on time.

    • If initial paperwork is not completed at least 24 hours before your appointment, you will be subject to cancellation and a fee.

    • If you arrive 10 or more minutes late, you may not be seen and will be subject to a no-show fee.

    • Repeated missed or late appointments may result in discharge from the practice.

  • Cancellations & Rescheduling:

    • Appointments may be canceled or rescheduled at least 48 hours in advance by calling our office.

    • Last-minute rescheduling (less than 48 hours before your appointment) may result in a rescheduling fee.

  • No-Shows & Multiple Cancellations:

    • A "no-show" is defined as missing a scheduled appointment without canceling in advance.

    • Multiple no-shows (2 or more) may result in discharge from the practice.

Medical & Prescription Policies

  • Medication Refills & Prior Authorizations:

    • Prescriptions are sent electronically to your preferred pharmacy.

    • Refills require at least 48 hours' notice and must be requested through your patient portal or by phone.

    • If you miss or are a no-show for your follow-up appointment, a refill fee may apply.

  • Controlled substances: Initial evaluations for controlled substances may require an in-person appointment and/or evaluation of your previous provider's records.

  • Pharmacy Policy:

    • You must provide your preferred pharmacy during your initial visit.

    • One free pharmacy change is allowed per year. Additional pharmacy changes in the same calendar year will incur a fee.

Emergency & After-Hours Care

  • During business hours: Call 240-669-7496 to request an emergency appointment.

  • After-hours emergencies: Call 911 or visit the nearest emergency room.

  • Crisis Resources:

  • Maryland/Montgomery County Mobile Crisis Team: 240-777-4000

  • Washington, DC Helpline: 1-888-7WE-HELP (1-888-793-4357)

  • Virginia Crisis Helpline: 988

Confidentiality & Privacy

DMV Medical Group will only release confidential information under the following conditions:

  1. With written consent from the patient.

  2. If there is a clear and immediate danger to the patient or others.

  3. By court order.

  4. In cases of suspected abuse or neglect of a child under 18.

  5. To the insurance companies for necessary treatment verification.

Physician Contact & Coordination of Care

  • If medical symptoms affect your psychological well-being, we encourage consultation with a medical provider.

  • We may coordinate care with your primary physician with your permission.

Patient Rights & Responsibilities

  • Freedom to Withdraw from Treatment:

    • You may discontinue therapy or medication management at any time.

    • DMV Medical Group reserves the right to discharge patients for multiple missed/canceled appointments or failure to adhere to treatment plans.

  • Testimonials & Reviews:

    • If you voluntarily leave a testimonial or review online, it may be shared on Google, Kareo, Tebra, or other social media platforms.

    • Any personal information you disclose is not protected once posted publicly.

  • Notice of Privacy Policies:

    • You have received a copy of our Notice of Privacy Policies before signing this agreement.

    • You have the right to revoke consent in writing at any time.

  • Advance Directives for Mental Health Treatment:

    • Maryland law allows you to establish an Advance Directive for mental health treatment, which outlines your treatment preferences and designates a healthcare agent.

    • Contact our office if you would like a copy of this directive.

Financial Policies & Fees

Payment Responsibilities

  • Payment is due at the time of service, including co-pays, deductibles, and co-insurance.

  • DMV Medical Group requires a credit/debit card on file in our EHR system and in our third-party billing system (Headway).

  • If a card is not on file the day before your appointment, DMV Medical Group reserves the right to cancel your appointment without notice.

Fee Schedule:

*All fees are subject to additional credit card or ACH processing fees of 3.06%.

Service Fees:

  • Initial Therapy Session $300*

  • Medication Management $225*

  • Talk Therapy $250*

  • Medication Management + Talk Therapy $375*

Cancellation & No-Show Fees:

Policy Violation Fees:

  • Late Cancellation (<48 hours) $200*

  • Rescheduling (<48 hours) $200*

  • No-Show for Any Appointment $200*

  • No-Show for Initial Appointment $200*

  • Two or More No-Shows May result in discharge

Additional Service Fees:

Service Fees:

  • Form Completion (Case-by-Case) starting at $225*

  • Medication Refill Without Appointment $225*

  • Additional Pharmacy Change $100*

Policy Agreement

I understand that DMV Medical Group, LLC has reserved my appointment in consideration of my promise to abide by the policies above.

By signing below, I authorize DMV Medical Group and its affiliates to charge my card on file for:

  1. Any co-pay, deductible, or self-pay amount on the day of my appointment.

  2. Any no-show or late cancellation fees as outlined above.

  3. Any additional service fees I incur.

I acknowledge that if my insurance denies payment for Telemedicine/Teletherapy, I will be responsible for the full payment.

Property of DMV Medical Group, LLC, 2026