Treatment Consent

Practice Policies Consent

Welcome to Kemet Health!

Kemet Health is a mental healthcare provider committed to improving the health & mental well-being of each of our members. We do this by providing affordable, timely and quality access to care, a mission that will never stop

Controlled Substances

We do not prescribe controlled substances out of our office. Commonly requested controlled substance prescriptions from psychiatrists include:

  • Stimulants: amphetamines, Vyvanse, Adderall, Ritalin
  • Benzodiazepines: Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), Ativan (lorazepam)
  • Opioids: Suboxone (opioid replacement)
  • Nerve pain: Gabapentin, Lyrica (state specific for whether we can prescribe)

We can explore other, safer alternatives as part of your treatment regimen. And we are able to help coordinate your care with outside providers as desired, such as primary care physicians. If you have specific prescriptions you are interested in obtaining and are unsure if they are controlled substances, please give us a call.


We strongly encourage that you access psychotherapy if you are obtaining psychiatric services at Kemet Health. Our psychiatric providers provide therapy as part of follow up visits for medication management (30 minutes). This means you will be billed for a combination of psychiatry and therapy services.

If you prefer shorter visits (15-20 minutes) with our psychiatric providers to bypass therapy with us, we require that you also see a therapist regularly and allow us to coordinate treatment with your therapist.

Personal Requests: Paperwork, Doctor's Note, Expert Opinion

Our main role is a treatment provider, not to complete specialty paperwork. We are able to consider the below requests once we have an established relationship of at least 4 visits. Depending on the request, we may not be able to assist you. We may charge a fee for paperwork requests, depending on the nature of the request and time required, and reserve the right to deny requests.

Able to Perform

  • Sick Notes: We can write notes excusing for work if requested by you or your employer.
  • DMV Form: We request an appointment to discuss the form in proper detail; insurance does not cover this, self-pay rates apply
  • Reasonable Accommodations
  • FMLA (Medical Leave)

Able to Assist, Not Able to Perform

  • Emotional Support Animals: referrals to and we can assist in the process.
  • Disability Evaluations: We do not perform these evaluations out of our office. (Social Security Income benefits). We are happy to send the notes from your evaluations to a third party with your consent.

 Not Able to Assist or Perform: we recommend contacting your local department of social services, a legal expert, or other mental health associations for referrals to forensic psychiatrist or psychologist.

  • Expert opinion or testimony / court-ordered forensic evaluations
  • Parenting evaluations (DSS, CPS, etc.) or custody/visitation evaluations
  • Fitness for duty / job readiness / functional capacity / evaluations to operate weaponry

Cancellation + No Show Policy

We need at least 24 hours’ notice to cancel your appointment, otherwise we charge a missed appointment fee. We have limited slots in our practice and want to do our best to serve everyone. Missed appointments also impact our ability to accept insurance for our services and keep treatment affordable for everyone. In order to maintain scheduling integrity, we have cancellation fees in place for cancellations below:

  • 30 minute scheduled appointment: $70.00
  • 60 minute scheduled appointment: $100.00
  • Reschedule within 5 days of original appointment: 50% off missed appointment fee

Distracted Driving

We are dedicated to eliminating distractions and unnecessary risks while engaging in telehealth interactions.

The following policies apply to any patient who is inside a motor vehicle during a telehealth session:

  • Patients must not operate a motor vehicle under any circumstance during a telehealth visit.
  • Patients are permitted to sit in their motor vehicle during a telehealth visit, granted the vehicle is stationary and not being operated. The vehicle should be parked in a secure and private location to ensure confidentiality during the visit.
  • Telehealth appointments cannot take place when a patient is in a moving vehicle, regardless of whether the patient is the driver or a passenger. This is necessary to maintain privacy and focus during the appointment. Exceptions to this specific item can be made but at the sole discretion of the Kemet Health provider.
  • If patients do not comply, they will be politely informed that it is unsafe to continue the session under these conditions, and the appointment will be rescheduled and then disconnected.
  • If an emergency situation arises and the patient needs to operate a motor vehicle, the video call should be disconnected and switch to a phone call to minimize risk of distraction while driving.

By participating in a telehealth appointment, each patient agrees, to the fullest extent permitted by law, to indemnify and hold harmless Kemet Health, its stockholders, partners, employees, officers, agents, and directors, from all claims, damages, losses, liabilities, and expenses—including but not limited to attorneys’ fees—incurred as a result of violating this policy. This agreement applies regardless of whether an accident, bodily injury, or property damage occurs.


Prior Authorizations

Your health insurance plan/benefit may require a prior authorization (PA) for your medication. Please be patient with us as PA’s are a complex coordination between us, your insurance, and your pharmacy.

We do have the option available to coordinate your medications with a specific mail-order pharmacy that offers significant discounts, if PA’s get in the way of you accessing your necessary medication. Please let us know if the PA process with your insurance is concerning to you, or if you have fears of running out of your medication.

In signing I understand the Kemet Health Practice Policies and agree to abide by it.

Including comprehension of the expected benefits and risks of telemedicine in treatment, and that I have the right to give consent for this service.

    Including comprehension of the expected benefits and risks of telemedicine in treatment, and that I have the right to give consent for this service.

    Please let parent, guardian, or your personal representative sign below:

    By submitting your signature, the parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.