PATIENT FORMS

When Dr. Tyrrell Baker confirms your consultation/intake appointment, patients need to complete these forms prior to the appointment (Click the name of the form to view):

1. Telemedicine consent

2. Office safety

3. Services and Fees agreement

4. Privacy Policy

5. Medical History

6. Consent for Release of Information

7. Patient Outcome Questionnaires

 

STANDARD FEES

Assessments/consultation sessions $200

Neurofeedback sessions $140 

FEES AND COPAYS DUE AT TIME OF SERVICE

You will be expected to pay full fees for each session at the time it is held, unless we agree otherwise. Dr. Tyrrell Baker is in network with Excellus BCBS and RMSCO. She would be considered an out of network provider with other insurances. If you have  out of network coverage for your plan, services may be covered at least partially.  In order for you to get reimbursement from your insurance company, we have to supply a clinical diagnosis to your insurance company that justifies the service as medically necessary.

MISSED APPOINTMENT FEES

You will be charged full session rate for any appointment that is cancelled with less than 24 hours notice. You are required to have credit card on file so that it can be charged automatically in accordance with the policy.

 

OTHER FEES

Dr. Tyrrell Baker's hourly fee is $200 for other professional services you may need. Other services include report writing, telephone conversations lasting longer than 15 minutes, attendance at meetings with other professionals you have authorized, preparation of records or treatment summaries, and the time spent performing any other service you may request. If you become involved in legal proceedings that require Dr. Tyrrell Baker's participation, you will be expected to pay for her professional time even if she is called to testify by another party. Because of the difficulty of legal involvement, Dr. Tyrrell Baker charges $400 per hour for preparation, travel, and attendance at any legal proceeding.