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Filling Out a Medical Form

BECOMING A PATIENT

  • Step One ... Welcome! We would love to have you as part of our Pinnacle family.

  • PLEASE NOTE: AS OF JANUARY 2024, WE WILL NO LONGER BE IN NETWORK WITH ANY INSURANCE CARRIERS.

  • IF YOU HAVE OUT-OF-NETWORK BENEFITS, WE WILL GLADLY PROVIDE YOUR SUPERBILL, SO YOU CAN SUBMIT IT TO YOUR INSURANCE COMPANY, TO SEEK REIMBURSEMENT.

  • There are companies, such as reimbursify.com, mentaya.com, and floatfi.com, that will submit the superbill and obtain reimbursement for you.

  • New patient evaluations (60-90 minutes): $360

  • Follow up visits (30 minute minimum): $120

TO BECOME A NEW PATIENT OF PINNACLE PSYCHIATRY:

  • AGE: We see patients ages 16 and up. Please ensure that your child (if you are the parent/guardian) is of the appropriate age for our practice.

  • INSURANCE: We are not in network with any insurance carriers, as of 2024.

  • FORMS: You must complete this New Patient Info and Consent to Treatment form.  Once complete, this form auto-uploads to your chart.

  • POLICY: Please carefully review our policy in the Consent to Treatment. This could directly impact your care, and we want you fully informed and on board before investing your time, energy, hard-earned money, and trust.

  • SCHEDULING: Once we receive your completed form linked above, we will call or email you within less than one (1) week, to get you scheduled.

  • IF YOU HAVE NOT HEARD FROM US IN ONE WEEK: 

    • First, make sure your voicemail box is not full! We encounter this problem frequently and cannot leave messages if voicemail is full.

    • Second, check your spam email folder. This happens occasionally as well, if we cannot reach you by phone and we try via email.

  • IF NONE OF THESE APPLY: We often experience very high new patient volume.  Thank you for your patience, and please call us if it's been one full week after you completed your new patient paperwork, linked above.

  • YOUR FIRST VISIT

    • Please allow a minimum of 60 minutes for the duration of your consult.  In rare cases, we may require an entire 90 minutes for your consult.

    • Please bring, or email/fax to us (FrontDesk@PinnaclePsych.com), all lab results that have been performed in the past six months, for our review. Labs (blood work, brain scans, medical records) are integral to your care!

    • We strive to run on time to the minute, as best we can, out of respect for all of our patients' time.  Please arrive at least 15 minutes early, so we can have you completely checked in and prepared to achieve the full benefit of your visit.

    • Patients who arrive late must be rescheduled.

TO BECOME A NEW PATIENT OF JENNIFER BELLINGRODT, PsyD:

NEW PATIENT DOCUMENTS

All forms can be easily completed and submitted electronically.

Should you have any trouble, you are welcome to print, sign, bring in, or email to us at FrontDesk@PinnaclePsych.com.

NEW PATIENT INFO & CONSENT TO TREATMENT

RELEASE OF INFORMATION

REQUEST FOR RECORDS

LOCAL THERAPISTS LIST

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