Forms and Policies

Required before appointment

New Patient Forms

Please fill the following form before your first appointment.

Other Forms and Policies

Referral Form

HIPAA Form

Release of Information

Payment Policy

Annual Consent Form

Office Policies

Controlled Substance Agreement

Luminous Mind Care Psychiatry Fees and appointment Policies

At Luminous Mind Care we’re in-network with most insurance plans and Medicare. Our staff will work with you to check your insurance plan’s mental health benefits – leaving you with one less thing to worry about.

Insurances Accepted:

Cigna, Aetna, United Healthcare, Optum, Medicare, Medicaid, Blue Cross/Blue shield and many more

If you don’t have insurance, or are out of-network, please call us for our rates.

I accept cash, check or credit card as payment.

Cancellation Policy

I am happy to cancel or reschedule your appointment if necessary. Appointment times are reserved just for you. All cancellations must be made at least 48 hours in advance of your scheduled appointment otherwise you will be charged the current rate for that appointment. You will also be charged if you fail to show up for your appointment. Emergencies will be taken into consideration.