Treatment Agreement


Read, Initial, & Sign

Policy Regarding Payment and Insurance

Payment for the Initial Evaluation is accepted at the time of service, either by check, electronic transfer, cash, or credit card (fee applies). Payment for episodic visits for medication management is accepted during or shortly after the date of service. Patients attending sessions more than once per month will generally be billed on a monthly basis, and payment is expected within ten days of the date of the statement. If, in the course of the work, collecting payment for sessions becomes a time consuming effort on his part, Dr. Cohen reserves the right to request payment in advance of scheduling future sessions.

Please note that Dr. Cohen is considered Out of Network for all insurance carriers (including Medicare), but he will provide you with a document containing all the relevant and necessary information for you to submit to your insurance company (not Medicare, however, for which a separate contract applies), and you will be reimbursed based upon your Out of Network benefits. Payment of your balance is never contingent upon reimbursement by your insurance company.

Please note that Dr. Cohen does not supply progress notes or medical records in response to requests from insurance companies seeking to evaluate coverage for psychiatric services. This may affect your ability to be reimbursed for Dr. Cohen’s services.

There may be other circumstances in which Dr. Cohen charges a fee for a particular service. However, you will be notified in advance of the service rendered.

Policy Regarding Cancellation and Missed Session

If you need to cancel or reschedule an appointment for medication management (30 minutes), 72 hours advance notice is required. If you cancel or reschedule within 72 hours of your scheduled appointment, or you miss an appointment, and Dr. Cohen is unable to fill the time slot, Dr. Cohen will charge the full fee for the session, irrespective of the circumstance causing the absence. Exceptions are made in the case of serious medical illness or family emergencies, at Dr. Cohen’s  discretion.

Patients in regularly scheduled psychotherapy(45 or 60 minutes) should consider their appointment times as fixed and a necessary aspect of the continuity of their treatment. These times have been reserved especially for the patient, and specifically withheld from others. Therefore, canceling or missing a regularly scheduled appointment carries the responsibility of the full fee for the session, unless the time can be filled by another patient. While Dr. Cohen is unable to guarantee, the possibility of rescheduling within the same calendar week may avoid the charge for a missed session, if his schedule is able to accommodate the change.

It is a common phenomenon in psychiatric treatment, especially in psychotherapy, that patients may miss sessions due to unconscious ambivalence. Human and technological error can interfere with your intention to keep an appointment. Lastly, environmental circumstances can interfere. Please understand that Dr. Cohen employs a simple, clear set of guidelines regarding your accountability for scheduled appointments, with the objective of minimizing misunderstanding or disappointment regarding treatment interruptions.

Policy Regarding Prescriptions


Prescriptions are optimally generated electronically during a patient’s session. Therefore, please assess your potential need for a prescription before each visit. Ask for renewal prescriptions at the beginning of a meeting, so that they can be completed in a timely fashion. 

Always check your medication bottles for the appropriate number of pills and refills when you pick them up from the pharmacy. Dr. Cohen cannot take responsibility for administrative errors on the part of a pharmacist. 

Please note that Dr. Cohen does not accept medication prescription and refill requests from a pharmacy. All prescription and refill requests must come from the patient to Dr. Cohen directly.

If you need a prescription for a medication, and you do not have an appointment in time to fulfill this need, please contact Dr. Cohen by email or text message. Dr. Cohen asks that prescription requests be made during business hours Monday through Friday, and only in an emergency over the weekend. Dr. Cohen also asks that you do not wait until your need for a prescription is urgent.

The following is necessary in the request for a prescription, as Dr. Cohen’s electronic prescribing program asks for very specific information:

  • The name of the medication (including brand name or generic) and its strength (mg per pill)
  • Number of pills taken daily (1 pill three times per day, 2 pills at bedtime, etc)
  • Your address, including zip code, and telephone number
  • Your date of birth
  • The name, full address, and telephone number of your pharmacy (specify local or mail order)

If Dr. Cohen has made a prescribing error, please contact him as soon as possible and he will rectify the situation.

Thank you in advance for your cooperation in making your treatment as cautious, safe, organized, and responsible as possible.  My first priority is superior and meticulous care of my patients. I promise that your compliance with the above will greatly contribute to the attainment of that goal.


Kenneth R. Cohen, M.D.

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