Clinic Policies
Prescribing
Medications for anxiety and sleep
Some medications for anxiety and sleep — the class that includes alprazolam, clonazepam, lorazepam, and diazepam — work quickly but are not intended for long-term daily use. Over time they tend to lose effect, become harder to stop, and add risks including falls, memory problems, and dangerous interactions with alcohol and opioids.
Our approach is as follows:
- We do not use these medications as a first treatment for anxiety, panic, PTSD, or insomnia. We begin with treatments that work better over time.
- If we do prescribe one, we will tell you why, for how long, and what the plan is to come off it. The longer-term treatment is started at the same time, not later.
- If you are already taking one when you come to us, we will not stop it abruptly and we will not continue it automatically. We will assess it and build a plan with you by your second visit.
- When a dose is reduced, the pace is set for you individually. There is no fixed schedule. If a step is too difficult, we slow down or pause, which is a normal part of the process.
- While a dose is being reduced, we use other medications and behavioral approaches to manage symptoms.
Prescribing rules
Controlled substances
The following rules apply to every patient who receives a controlled substance from this practice, including stimulant medications, buprenorphine, and medications in the class described above.
- Controlled substances are prescribed by this practice only, and filled at a single pharmacy that we have on file.
- Urine drug testing may be required at any time, including at your first visit and at intervals afterward, on a scheduled or unannounced basis.
- The state prescription monitoring program is checked before a controlled substance is prescribed and at intervals during treatment.
- Early refill requests are not routine.
- If you cannot be seen before your supply runs out, the physician may issue one bridge prescription of up to 7 days at the same dose, at his discretion and only when a visit has already been scheduled.
- Lost, stolen, or damaged medication and prescriptions are not routinely replaced. Report the loss to the office immediately. For a reported theft, a police report and an appointment are required before a replacement will be considered.
- A written controlled substance agreement may be used where the circumstances warrant one. It is not required of every patient.
Refills
Refills, and how often you will be seen
Routine refill requests may be submitted through the patient portal or by your pharmacy. Please ask for refills at your appointments where possible, rather than when you are close to running out.
Prescriptions continue only while you are being seen. Patients receiving prescriptions from this practice are seen at least every three months. Three months is a maximum interval rather than a standard one; shorter intervals apply when the medication, the diagnosis, or your circumstances call for them, and controlled substances generally require shorter intervals.
A refill is not issued when the interval between visits has passed, when the dose or medication is changing, when required monitoring is overdue, or when the last visit raised a question we would prefer to address in person. In those situations, an appointment is offered.
New patients
New patient appointments
New patient appointments are for evaluation and medication management only. We do not schedule evaluations for FMLA, disability, or workers' compensation.
Forms, letters, and questionnaires are completed for established patients, meaning patients who have been in treatment with us for about three months. A form makes statements about a course of treatment, and we are not able to make those statements before treatment has been underway for a period of time.
There is no charge for any form or letter. Brief notes and extended forms alike are included in the visit at which they are completed.
Paperwork is completed during a scheduled visit rather than from the inbox. Please bring the form or send it ahead of the appointment, and it will be discussed and signed at the visit.
Letters and forms state what the physician has observed and treated: the diagnosis, the functional limitations, and the treatment provided. They do not certify that a particular accommodation, animal, housing arrangement, or leave is required, because those determinations belong to the employer, housing provider, or agency that is asking the question. Where the record does not support what a form asks, the form will say so.
Call 972-332-5922 to schedule, or book online. If you have a question first, call the office and we will answer it.
Video visits
Telehealth
Initial evaluations take place in our office. Follow-up appointments may be conducted by video through the patient portal.
You must be physically located in Texas at the time of a video visit. You will need a device with a working camera and microphone, a reliable internet connection, and a private place to speak. Please do not join a visit while driving. Sessions are not recorded by either party.
Video visits are the same length as office visits, carry the same fee, and are subject to the same cancellation policy. We may ask you to come to the office when an examination, vital signs, or laboratory monitoring is needed, when a controlled substance requires an in-person visit, or when symptoms have changed significantly. TMS and Spravato are office-based treatments.
Privacy
Your health information
Your medical record is confidential. We use and disclose your health information for treatment, for payment, and for the operation of the practice, and otherwise only with your written authorization or where the law requires or permits it.
You will receive our Notice of Privacy Practices at intake. It describes how your information is used and disclosed and what rights you have with respect to it, including the right to request restrictions on certain disclosures, the right to request confidential communications, and the right to an accounting of certain disclosures. The complete notice is on the Privacy page.
Nothing is disclosed to a family member without your written authorization naming that person and the information that may be discussed. You may withdraw an authorization at any time. We may receive information from a family member at any time without an authorization, and receiving information is not the same as disclosing it.
Records of substance use treatment carry protections beyond those that apply to the rest of a medical record, under federal regulations that govern that information specifically. Information from that part of your record is not released without confirming which rules apply to the request.
Records
Requesting your records
You may request a copy of your medical record in writing, in person, or through the patient portal. We will ask you to complete an authorization form so that we have a record of what you asked for and where it is to be sent.
Records are provided at the rates set by Texas law. Records are released whether or not there is a balance on your account.
Where records are being sent to another treating clinician, tell us and we will send them directly.
Transitions
Ending a treatment relationship
Either you or the practice may end the treatment relationship. You may do so at any time, and we ask only that you tell us, so that we can note anything in your care that needs continued attention and provide the release form for transferring your records.
If the practice ends the relationship, you will receive written notice. Care continues for 30 days from that notice for urgent needs and for prescriptions, so that you have time to establish care elsewhere. Where a controlled substance is involved, that period is extended when it is necessary for you to reach your first appointment with the next prescriber. We will provide a release form and assist with transferring your records.
Emergencies
Communication and emergencies
Portal messages are read during office hours. The portal is not monitored in the evenings, on weekends, or on holidays.
Messages are appropriate for refill requests, scheduling, billing questions, a side effect question that can be answered briefly, and questions about laboratory results or about something already decided at a visit.
Some matters need a visit rather than a message. These include a change to your treatment plan, a new or worsening symptom, a dose change, any question about risk or safety, a request for a form or letter, and any question that requires more than a short answer. When that is the case, we will tell you and offer you an appointment.
The office is open Monday through Friday, 8:00 a.m. to 5:00 p.m. Calls received after hours are picked up when the office reopens.
In an emergency, call 911, go to the nearest emergency room, or call or text 988. The portal and voicemail are not monitored in real time and are not appropriate for an emergency.
Prescriptions continue only while you are being seen.
Schedule
Getting started
Call 972-332-5922 to schedule, or book online. If you have a question first, call the office and we will answer it.