Reynolds Psych NP

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Personal Information:
Insurance Information (if applicable – optional if self-pay):
Important Note on Payment:

No payment is required at the time of booking or during your appointment.

For self-pay clients, a secure payment link will be sent 12–20 hours before your appointment. This link expires within 24 hours.

Payment is required prior to your appointment — services will not be provided without completed payment.

If you have any questions about fees or payment, please contact us before booking. Thank you for understanding!

If Self-Pay:

No payment is collected at booking or at the time of your appointment.

A secure payment link will be sent 12–20 hours prior to your appointment, expiring within 24 hours.

Payment must be completed before your appointment begins — services will not be provided without payment.

Consent & Confirmation: I understand and agree to the following:

No payment is required at the time of booking or during the appointment itself.

For self-pay clients, a secure payment link will be sent 12–20 hours before the appointment and expires within 24 hours.

Payment is required prior to the appointment — services will not be provided without completed payment.

The information provided above is accurate and complete.

I authorize the use of my insurance information (if provided) for billing and verification purposes.

By clicking Book Now, I hereby certify that I have read, understood, and agree to the above-mentioned points, the Terms & Conditions, and the Privacy Policy.

Appointment-Form

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Personal Information:

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We accept all major credit cards for private pay patients.
At this time, we do not accept Cash App, Venmo, Zelle, or PayPal, as these platforms are not HIPAA-compliant under federal regulations.

A secure payment link will be sent to the email address you provide during registration within 24 hours of your scheduled appointment.

Payment is required before your session begins, but only after you receive the payment link from your provider.

If payment is not completed before your appointment start time, your visit may be canceled unless prior arrangements have been made.

Please note: The payment link expires 24 hours after it is sent. If you do not receive your link or experience any issues, please contact your provider directly.

If you plan to use insurance, please provide the following before your visit:

  • Insurance carrier name
  • Member ID number
  • Group number

We currently accept the following insurance plans:

  • Anthem Blue Cross Blue Shield
  • Aetna
  • Cigna
  • United Healthcare
  • UMR
  • Carelon Behavioral Health
  • Carelon Behavioral Health IPA Strategies
  • Carelon Behavioral Health of California
  • Massachusetts Behavioral Health Partnership
  • Carelon Health of New Jersey
  • Blue Cross Blue Shield of Massachusetts
  • Horizon Blue Cross and Blue Shield of New Jersey
  • Oscar Health
  • Oxford
  • Carelon Health Federal Services
  • Carelon Health of Pennsylvania
  • Carelon Behavioral Health IPA
  • Carelon Behavioral Health Strategies

We offer sliding scale pricing based on income for eligible patients.
Please discuss this option with your provider at least 24 hours before your first appointment.

Cancellation Policy

We kindly ask for at least 24 hours’ notice if you need to cancel or reschedule your appointment.
Cancellations made with less than 24 hours’ notice may result in a $40 cancellation fee.
You may cancel or reschedule by:

If this fee would cause hardship, please let us know. In special circumstances, the fee may be waived at the discretion of management.
Missing more than two appointments within a 12-month period may result in a review of your care and possible discharge from the practice.

Patients are allowed a maximum of two no-call/no-show appointments within a 12-month period.

A no-call/no-show occurs when an appointment is missed without advance notice.
Exceeding this limit may result in dismissal from the practice.
We value consistent attendance as it helps us provide the best care possible.

Private Pay Patients

You will receive a secure payment link by email. Payment must be completed within 24 hours to confirm your appointment.

Insurance Patients

After submitting your insurance information, you will receive an email from either Headway or Grow Therapy, depending on your insurance provider. These platforms manage insurance billing on our behalf.

Reynolds Psych NP is committed to providing ethical, evidence-based psychiatric care. Completion of medical paperwork—including FMLA, short-term disability, long-term disability, accommodation requests, and similar certifications—requires sufficient clinical information and an established treatment relationship.

Medical certifications are completed only for established patients with whom the provider has adequate clinical knowledge. This allows for appropriate assessment of diagnosis, symptom severity, and functional limitations.

While no federal or state law mandates a specific timeframe, Reynolds Psych NP follows widely accepted clinical standards:

  • FMLA evaluations:Typically require a minimum of two clinical visits or approximately 30 days of active treatment.
  • Short-term disability evaluations:Typically require 6–8 weeks of ongoing treatment with documented symptom persistence and functional impairment.
  • Long-term disability evaluations:Typically require several months of continuous treatment with thorough documentation.

These timeframes may vary based on clinical complexity, prior records, and individual circumstances.

Paperwork requests are not routinely completed during an initial evaluation or first visit. Additional visits may be required to establish diagnosis, treatment response, and functional impact before paperwork can be considered.

Completion of paperwork is not automatic and is determined by the provider’s clinical judgment. Reynolds Psych NP may decline or defer paperwork if:

  • Clinical information is insufficient
  • Documentation does not support the requested certification
  • Treatment adherence has not been demonstrated
  • The request falls outside the provider’s scope or standard of care

When clinically appropriate, paperwork evaluations may be completed via telehealth. In-person visits may be required in certain cases at the provider’s discretion.

Paperwork completion may involve additional administrative fees and typically requires processing time beyond the scheduled appointment. Patients will be informed of any applicable fees in advance.

Patients are encouraged to:

  • Discuss paperwork needs early in treatment
  • Bring required forms to appointments
  • Allow sufficient time for evaluation and completion

Scheduling an appointment does not guarantee paperwork completion.

If you have questions about paperwork eligibility, please contact the office prior to scheduling.

Payment Methods:

Private pay patients may use all major credit cards for payment. However, Cashapp, Venmo, Zelle  and PayPal are not acceptable forms of payment as they are not HIPAA compliant, in accordance with government regulations.

Phone number (262) 829-7236 – Only texts are accepted via this phone number.

A payment link will be sent to the email address provided during registration within 24 hours of the scheduled visit. If a different email address is preferred, please contact the provider to update the information. Payment for the session is required prior to the start of the visit.

However, please note that payment is not required until you receive the payment link from the provider. If payment is not submitted before the session begins, the appointment will be canceled, unless prior arrangements have been made with the provider.

Insurance and Fees:

Fees will apply for patients who do not have insurance coverage. Patients with insurance are required to provide their insurance information, including the name of the carrier, ID number, and group number, prior to the visit.

  • Anthem Blue Cross Blue Shield
  • Aetna
  • Cigna
  • United Healthcare
  • UMR
  • Carelon Behavioral Health
  • Carelon Behavioral Health IPA Strategies
  • Carelon Behavioral Health of California
  • Massachusetts Behavioral Health Partnership
  • Carelon Health of New Jersey
  • Blue Cross Blue Shield of Massachusetts
  • Horizon Blue Cross and Blue Shield of New Jersey
  • Oscar Health
  • Oxford
  • Carelon Health Federal Services
  • Carelon Health of Pennsylvania
  • Carelon Behavioral Health IPA
  • Carelon Behavioral Health Strategies

We do accept sliding scale payments which are discounted prices that are income based.  Please discuss sliding scale payments with the provider at least 24 hours before your first visit.

Cancellation Policy:

To cancel an appointment, please provide at least 24 hours’ notice. Cancellations made with less than 24 hours notice will incur a $40 cancellation fee.

We understand that sometimes plans change. If you need to cancel or reschedule, please contact us no later than 24 hours before your scheduled appointment. You may do so by calling (262) 999-7350, emailing [email protected], or using the patient portal.

If you are unable to provide 24 hours’ notice, a $40 no-show fee may apply and will need to be paid before your next appointment. If this fee could impact your care, please let us know.

In cases of emergency or special circumstances, we may consider waiving the fee at the discretion of practice management.

We kindly ask that no more than two appointments be missed within a 12-month period. Exceeding this may lead to a review of your future appointments with the practice, and in some cases, could result in dismissal from the practice.

Please note that the payment link will expire 24 hours after being sent. The link will be provided within 24 hours prior to your scheduled visit. If you do not receive the link or encounter any issues, please contact the provider directly for assistance.
 

No-Call/No-Show Policy

Patients are allowed a maximum of two (2) no-call/no-show visits within a 12-month period. Exceeding this limit may result in dismissal from the practice. A no-call/no-show is defined as failing to attend a scheduled appointment without providing notice in advance. Consistent attendance and communication are critical for the effective management of patient care.

FMLA Assessment Fees:

  • The fee for an FMLA assessment is $200, in addition to the initial psychiatric evaluation fee of $300.


Disability Assessment Fees
:

  • The fee for a disability assessment is $300, in addition to the initial psychiatric evaluation fee of $300.
  • Disability assessments are only for psychiatric conditions.

Assessment Timing:

    • Assessments for FMLA and disability purposes will only be considered after a minimum of 60 days of established care with the psychiatric provider.
    • Each assessment (FMLA and disability) will require a separate visit.

Electronic Forms and Appointment Cancellation:

Patients will receive an email containing electronic forms, including consent to treatment, privacy policies, the HIPAA Privacy Notice, a Mental Health Intake form, and few questionnaires. These documents are essential for the provider to prepare for the visit and develop a treatment plan tailored to the patient’s needs.

For patients paying by Cash App, credit card, or bank account:
Patients will receive a secure payment link via email. Payment must be completed within 24 hours to confirm the appointment.

For patients using insurance:
After submitting the required information, patients will receive an email from either Headway or Grow Therapy. These platforms handle insurance billing, and assignment depends on the patient’s insurance provider.

We do accept sliding scale payments, which are discounted rates based on income. Please discuss sliding scale payment options with the provider at least 24 hours prior to your first visit.

 

Insurance and Fees:

Fees will apply for patients who do not have insurance coverage. Patients with insurance are required to provide their insurance information, including the name of the carrier, ID number, and group number, prior to the visit.

  • Anthem Blue Cross Blue Shield
  • Aetna
  • Cigna
  • United Healthcare
  • UMR
  • Blue Cross Blue Shield of New Jersey
  • Horizon Blue Cross and Blue Shield of New Jersey
  • Oscar Health
  • Oxford
  • Blue Cross Blue Shield of Massachusetts
  • Horizon Blue Cross and Blue Shield of New Jersey
  • Oscar Health
  • Oxford

Medicaid and Medicare:

We are now credentialed to accept Medicare and Medicaid patients. Please note that according to Medicare and Medicaid policies, patients are not permitted to pay for their own visits. Kindly inform the provider about your Medicare or Medicaid coverage prior to your appointment.

We do accept sliding scale payments which are discounted prices that are income based (proof of income will be needed).  Please discuss sliding scale payments with the provider at least 24 hours before your first visit.

Sliding scale payments are based on income.

Payment Methods:

Private pay patients may use all major credit cards for payment. However, Cashapp, Venmo, Zelle  and PayPal are not acceptable forms of payment as they are not HIPAA compliant, in accordance with government regulations.

Phone number (262) 829-7236 – Only texts are accepted via this phone number.

A form of payment will need to be entered through the link that is sent to them within 24-48 hours of their scheduled visit

Payment Methods:

Private pay patients may use all major credit cards for payment. However, Cashapp, Venmo, Zelle  and PayPal are not acceptable forms of payment as they are not HIPAA compliant, in accordance with government regulations.

Phone number (262) 829-7236 – Only texts are accepted via this phone number.

A payment link will be sent to the email address provided during registration within 24-48 hours of the scheduled visit. If a different email address is preferred, please contact the provider to update the information. The payment must be completed prior to the start of the visit. While payment can be made immediately before the session, failure to submit the fee before the session begins will result in cancellation, unless prior arrangements have been made with the provider.

Cancellation Policy:

To cancel an appointment, please provide at least 24 hours’ notice. Cancellations made with less than 24 hours notice will incur a $40 cancellation fee.

We accept the following insurance carriers through our third-party billing company, Headway:

Patients must provide advance notice to avoid the risk of dismissal from the practice. Failure to attend scheduled appointments or provide sufficient notice may result in dismissal. To cancel or reschedule an appointment, please contact us at [262-999-7350]. If you are unable to speak directly with the provider, you must leave a voicemail message. Alternatively, you may send a text message to the same number as outlined in our cancellation.

Only 2 appointments can be missed in 1 year, otherwise there is the risk of being dismissed

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