FIRST VISIT

Please fill out and print the forms below. Bring them with you for your/your child’s first appointment.

Please arrive early if you are planning to fill out the forms at the office.

Child & Adolescent Intake Package
Adult Intake Package
Release of Information

Office Policies

  1. Confidentiality:
    Please review the copy of privacy practices before signing this document. We maintain a record of your treatment. You have certain rights with regard to accessing that record. Please direct your inquiries about access to your records to Dr. Arman Danielyan. Communications between the patient/parents/guardians are confidential. No information will be released to the third party without your consent, except for the following situations:
    – Consultation with other current health care providers, if pertinent to treatment;
    – Instances where the patient may be an imminent threat to self or others, unable to take care of his/her basic needs, or in cases of suspected child or elder abuse;
    – When ordered by a court;
    – Some treatment information such as name, diagnosis, date of service and charge is routinely given to your insurance company to facilitate reimbursement;
    – Some companies request additional information for treatment authorization
  2. Appointments and Cancellations:
    All sessions are arranged by appointment only. Please be on time for your appointment. Sessions cannot be extended if you arrive late. Monday appointments require notification before 5:00 p.m. the preceding Friday. Cancellation of your appointment on any other day of the week should be made at least 48 hours in advance.
  3. Prescription Refill Requests:
    – In order to continue to prescribe a medication, Dr. Danielyan needs to see you in person in order to assess for efficacy and side effects and potentially make additional adjustments;
    – Anticipate any refill needs and discuss during the office visit;
    – Requests for refills may take up to 72 hours and are not done on weekends or holidays.
  4. Telephone Access:
    Dr. Danielyan will return your phone calls within 24 hours. Please call 911 or report to the nearby Emergency room in case of any medical or psychiatric emergency. Please to do not email Dr. Danielyan in case of any medical or psychiatric emergencies.
  5. Fee for Service:
    – Dr. Arman Danielyan’s outpatient private practice is based on fee-for-service reimbursement model. Dr. Danielyan will not accept payment from your health insurance career. If you have health insurance, Dr. Danielyan will provide you with an insurance statement with the appropriate billing and diagnostic codes that you can use to submit to insurance yourself.
    – Payment for the appointment fee and any ancillary charges is due at the beginning of every session. You can submit your payments by sending a check, or you can pay at the time of your visit.