Client and Health History Forms, Billing and Insurance Forms
Print and complete these four new client forms and then mail them or drop them off at the office at lease one week prior to your initial consultation date.
Policies and Procedures for Clients of Sharon L. Doss, Ph.D. CCC
Authorization to Release Information to the client’s insurance company
Additional Health and History Forms
If requested, please complete one or more of these additional forms and return to our office prior to your initial consultation. Please provide as much information as possible, so that Dr. Doss is best prepared to work with you.
Questions about your child’s fluency
Statement of Clinical Policies
Initial Diagnostic Evaluation and Consultations
An initial assessment is typically recommended for new clients. Fees for services vary based on the age of the client, the amount of time require for testing, report writing, and follow-up conversations with referring physicians, teachers, insurance companies and other referral sources.
It is your responsibility to obtain pre-authorization if your insurance policy requires pre-authorization before services are rendered. We will assist you in this process whenever possible. Usually obtaining pre-authorization involves a telephone call to your primary care physician.
Subsequent to the initial evaluation or consultation, we will make recommendations about session frequency if therapy is indicated. Frequency of sessions is typically based on your child’s age, severity of delays, type of treatment required and other factors.
In general, younger children in treatment attend 30 minute or 45 minute sessions twice a week and older children attend one or two one-hour sessions each week. Typically, the last five minutes of the session is reserved to answer questions, discuss progress, and suggest activities to reinforce specific techniques at home.
Fee schedules for initial assessments/consultations, therapy sessions, conferences, extended telephone conversations and preschool/school observations are available upon request.
Scheduling and Attendance Policy
Please arrive on time for your appointment. If you arrive late, your therapy session may be cut short, out of courtesy to the clients whose appointments are scheduled after yours.
We make every effort to honor your scheduled appointment time, but occasionally, circumstances that cause us to get behind do arise. If we are running late, be assured that we will not reduce the length of your scheduled session.
If you must cancel or reschedule your appointment, please call (512) 453-3601 as soon as possible. We understand that families can’t always anticipate missed appointments – especially when children get sick during the school day — so, while we reserve the right to charge you for the full session fee if you cancel or miss a session without providing 24 hours notice — we generally waive fees for appointments missed because of unavoidable and unanticipated reasons. If you miss or cancel scheduled sessions frequently, we may need to re-evaluate your scheduled time.
Of course, we realize that there are times when you will need to reschedule your appointment and we will do our best to accommodate your needs. In turn, we may ask you to do the same on occasion.
Please note that we follow the Austin Independent School District calendar for Spring Break and the Winter Holiday Schedule.
Office Policies for Client Billing, Insurance and Payment
We bill for therapy sessions by the calendar month.
Your payment is due on the last date of the calendar month on which you have a scheduled session.
We accept cash, checks, and most major credit cards.
Insurance and Payment
Please let us know if you want an office statement summary that you may send to your insurance company. We ask that you pay us and then obtain reimbursement from your insurance company, but we make exceptions when necessary.
Standardized Insurance Forms. We can complete a standardized insurance form for those with insurance policies that require this special format.
Co-Payments* – If your insurance policy specifies a co-pay, you are responsible for the co-payment amount on the last date of the calendar month on which you have a scheduled session.
Direct Billing* – In some circumstances, we will bill your insurance company directly.
* You are responsible for all charges incurred if we do not receive payment from your insurance company within 30-45 days.
We ask all new clients to read, sign and date a copy of our policies form. Please download a copy here and sign it, so that you may bring it to your first appointment.
If you have any questions or comments regarding our policies, please ask.
We are strongly committed to safeguarding our clients’ privacy on this web site. Personally identifiable information (name, email address, or home address, etc.) is never revealed, sold, or made public for any reason to other individuals or businesses.