Policies and Guidelines

General Office Principles, Policies and Guidelines

(updated 5/2/2021)

On becoming a patient:

Initial evaluation:

  • Our first appointment will be a consultation only which generally lasts one hour.

  • Filling out these forms is required prior to our first visit. They help us make the most of your first appointment.

  • Further appointments may be required for me to complete this consultation, before I can conclude my assessment and discuss treatment recommendations.

  • At the end of the initial evaluation or consultation, we will make a mutual decision on whether my practice fits your needs and expectations.

  • I will do my best to provide recommendations that meet your needs, expectations, and abilities. I will not initiate any treatment or prescribe medications if that is not the case.

  • If I cannot meet your needs I will not be able to accept you as a patient.

  • In case you may not agree with my recommendations, and decide we are not a good fit, my initial appointment fees still apply, even if you decide to not continue our relationship.

  • If you miss the initial appointment, it will NOT be rescheduled.

Communication and Collaboration with other providers:

  • I recommend patients have a primary care provider (a family physician or internist).

  • If you have had previous mental health providers, I may find necessary request to communicate with them or obtain records before we begin treatment.

  • If you are seeking a second opinion, I welcome such consultation, but also request to have an opportunity to communicate with your other provider(s).

  • If you are transferring care to me from another provider, please understand that I may not agree with their treatment plan and may not be able to automatically renew the medications you have been receiving.

  • I will however review your past records and history and we will work on the most appropriate treatment plan together.

  • If you don’t agree to have your records sent to me, this is your choice, but in some cases I may not feel comfortable taking on someone’s care without being able to review their records.

Frequency of appointments:

  • The frequency of our appointments will be variable depending on your needs (generally ranging from once a week to once a month)

  • It is expected that every patient is seen for an appointment at least once every 3 months, unless we agree to a different frequency.

  • If you have not been seen in over 3 months, your chart will be closed automatically, and I will not be responsible for your care or further prescriptions.

Telemedicine appointments:

  • I only provide appointments by video-conferencing technology (also called "telemedicine" or "telepsychiatry") for your convenience.

  • This may not be suitable to all patients.

  • If upon screening or initial evaluation my assessment is that telemedicine is not a good fit for you or will not meet your needs, I will provide you with names of other providers or clinics that offer treatment in person. In that case, I will not continue providing you care.


  • Please notify me at least a week in advance if you require a medication refill.

  • Because it is not safe for me to continue providing medications without appropriate monitoring, my policy is to only provide refills if you have a future appointment scheduled.

  • I do not prescribe controlled substances (e.g. stimulants for treatment of ADHD, benzodiazepines, certain sleep aids, among others). This is in compliance with federal law regarding telemedicine services.

  • If you need a controlled substance to treat your condition, I can refer you to a psychiatrist who can provide in-person treatment, or provide recommendations to your primary care physician, in case they feel comfortable prescribing that type of medication.

  • If you feel the need to have a different dose of the medication, you must schedule an appointment to review your treatment.

  • Controlled prescriptions that other doctors may be prescribing you are confirmed by the online state prescription database, as per state requirements, to ensure that duplicate prescriptions are not written by other prescribers.

  • When consulting the Washington Prescription Monitoring Program database, I must enter your name and date of birth, identifying myself as your provider.

  • You are responsible for updating all your physicians of any new medications that are prescribed to you.

  • At times an unscheduled toxicology screen may be necessary during treatment, either to monitor for presence of any illicit substances or confirm compliance with a certain medication.

  • I expect that I will be the only provider prescribing psychiatric medications during our treatment.

Prior Authorizations:

  • Many insurance companies require a “prior authorization” for some medications.

  • I may need to charge you for that, as it can be very time consuming (see “Fees” below).


  • You may file a claim with your insurance on your own, using the statements that will be provided to you. They contain the codes your insurance requires.

  • I do not bill insurances. I do not file claims on your behalf, and I will not be available to assist you in filing claims or engaging in any correspondence with the insurance company.

  • I do not accept any new patients with Medicaid or Medicare at this practice location at this time.

Fees and Payment:

  • Payment is expected in full at the time of each appointment, paid by debit, HSA or credit card.

  • Consultation for PCP or second opinion (90 - 120 minutes): $600

  • New patient (first visit - 1h): $425

  • 25 min (medication management): $225

  • Phone call - less than 5 minutes: no charge

  • Phone calls over 5 minutes, prior-authorization for medications, forms, etc: Pro-rated charge based on an hourly rate of $300. Your insurance will likely not reimburse you for this type of fee.

  • Should you experience a financial hardship during the course of treatment, please discuss it with me so we can come up with a plan of action immediately in order for you not to have an interruption in your care.

  • Prior to a first appointment, you agree to provide a payment method, such as a credit, debit, or HSA card. You consent that a hold of $150 will be placed on your card. By signing this form, you indicate you understand that if you cancel your intake appointment with less than 48 hours notice, it will be charged for that amount, and that if you no-show to your intake appointment, the full fee for the intake appointment will be charged. (A cancellation with more than 48 hours notice will be fully refunded).

Cancellations / Missed Appointments:

  • If you are late for the appointment, I am not able to extent its time, as it will interfere with care of the next patient.

  • You will be charged for the full appointment.

  • You will not be charged for cancellations made more than 24 hours in advance.

  • You can cancel or reschedule an appointment by using the online portal.

  • Cancellations made less than 24 hours in advance are billed at 1/2 the appointment rate.

  • Missed appointments are billed at the same rate as the scheduled length of time of your visit.

  • If you are more than 15 minutes late I consider that a missed appointment.

  • Your insurance will likely not reimburse you for this type of fee.

Contact Between Appointments:

  • Although I generally make myself very available to patients and encourage contact with any questions or concerns, I cannot be available for your needs 24/7.

  • You may contact me by calling, emailing or using your Patient Portal at https://app.luminello.com/auth/login. I will do my best to respond within 48 hours.

  • As a solo physician, I do not have weekend or evening coverage.

  • Please note that information exchanged by email may not be secure. The online portal is more appropriate for communication.

  • If you ask more detailed clinical questions by email, I will likely ask you to schedule an appointment.

  • Any communication will become part of your medical record.


● Emails are never appropriate in use in an emergency.

● Should an emergency arise and you cannot reach me immediately, please call 911 or proceed to the nearest emergency department.

● You can also call the 24-hour King County Crisis Line at 211.

● Should you be hospitalized at any time, I anticipate that the inpatient physician coordinate care with me.

If that is not done, I may not be able to continue medications that were prescribed in the hospital if I find the treatment plan to be unwarranted or potentially harmful.

No photography, video, or audio recording is permitted in sessions.

Services I do NOT provide:

  • Controlled medication prescriptions

  • Emotional Support Animal Letters

  • Disability Evaluations

  • Forensic Evaluations

  • L&I assessments

  • Assessments for ability to return to work, ability to own a weapon, ability to drive a certain vehicle, etc.

  • Transcranial Magnetic Stimulation / Electroconvulsive Therapy – I can refer you to outside services.

  • Suboxone Treatment

  • Couples or Family Therapy

  • Court-ordered treatment, or treatment under the Washington Involuntary Treatment Act (ITA)


You have the right to review and obtain a copy of your health information, with limited exceptions. You may request a copy of your records by submitting a written request to Niels Nielsen, MD. There may be a nominal fee to cover printing/photocopying and shipping costs.

On becoming a former patient:

People end treatment with their physicians for many reasons. It’s best to talk with me about reasons for ending our treatment relationship so that if needed I can help with your transition. On some occasions I may encourage a patient to seek treatment with a different psychiatrist if they do not seem to be benefiting from treatment with me or simply require a different setting or different expertise. Like most important decisions regarding relationships, this one is best made after discussion and input from patient and physician. The success of any physician-patient relationship depends greatly on indefinable qualities we sometimes refer to as "chemistry." Because of this I want you to feel free to discuss with him your interest in changing to a different physician.

On rare occasions I may also find it necessary to terminate our treatment without your agreement. For example, this may be done if you choose not to comply with treatment recommendations to such an extent that the treatment is ineffective. Treatment may also be terminated if:

  • You fail to keep two appointments: either no-show or less than 24 hours.

  • You fail to return for an appointment at least every 3 months (unless we agree to a different frequency). If you wish to resume treatment at a later time, a new comprehensive assessment may be necessary.

  • You fail to participate in or misuse your treatment.

  • You do not agree with my treatment recommendations, despite my best efforts to find a treatment that matches your preferences.

  • You do not pay your bill at the time of each appointment.

  • You engage in any unprofessional, intimidating or threatening behavior.

  • You do not follow through on my treatment recommendations.

  • You see another psychiatrist or physician for management of the same or related condition and do not notify me.

  • I am not comfortable with medications prescribed to you by another provider.

  • You require a higher level of care, or different treatment that I am not equipped to provide.

  • You misuse medications or obtain duplicate prescriptions from other providers.

  • You are suspected of trading, selling or giving away a medication.

  • You make a request for me to misrepresent diagnosis or level of functioning in order to obtain benefits that you are not entitled to.

Please note that I reserve the right to terminate any patient from my practice without providing a reason.

Under certain circumstances I will remain responsible for your care for up to thirty days after I have advised you that I will no longer provide care. This may or may not include providing continued medication refills at my discretion.