Updated Clinic Policies

Psychiatric Evaluation: $400.00

• This service is for psychiatric care only.

Comprehensive Care Evaluation: $500.00

• This includes primary care, psychiatric services, and weight management, if desired.

Weight Management Evaluation: $400.00

• This service is for weight management only.

Important Payment Information:

• All new patient evaluations require a $200.00 non-refundable deposit at the time of scheduling. The remaining balance is due at the time of your appointment.

Please note: If the full payment isn’t made at your appointment, it will be considered a “no-show” and you will forfeit your $200.00 deposit. There are no exceptions to this policy.

• Dr. Uddin will determine the appropriate timing for all follow-up visits.
• The cost for a follow-up appointment is $200.00, due at the time of your visit. There are no exceptions.
• A $100.00 charge will be applied for any “no-show” appointments.
• Cancellations made within 24 hours of your scheduled appointment will also result in a $100.00 charge.
• If you don’t make full payment at the time of your appointment, it will be considered a “no-show,” and you will be charged a $100.00 no-show fee. This fee must be paid within two weeks of the missed appointment.

Note: In the case of an extenuating circumstance, discretion may be applied on a case-by-case basis

• We do not accept any form of insurance, including commercial and federal plans like Medicare and Medicaid.
• You can pay with cash, a credit or debit card, or an HSA/FSA account. All patients are required to have an active card on file.
• We reserve the right to charge your card for any outstanding balance.
• We do not issue refunds for services that have already been provided.
• We do not offer a sliding scale or payment plans.

• Please allow 48 to 72 hours for all refill requests.
• Medication refills may not be honored if you have missed, canceled, or rescheduled an appointment outside of the recommended time frame.
• Extenuating circumstances may be considered on a case-by-case basis.

• Please allow at least 72 hours for us to complete any paperwork you request.
• Dr. Uddin charges a $50.00 fee for completing forms such as FMLA, short-term disability, or ADA paperwork. This fee is due before the form is completed.
• Renewals or extensions of these forms are $25.00.
• Any letters written to an entity or organization (e.g., a school, court, or workplace) will be charged at $25.00.

• Dr. Uddin reserves the right to terminate a patient’s care at his discretion at any time.
• If a patient has three missed appointments, including “no-shows” or cancellations/reschedules within 24 hours of the appointment, it will result in immediate termination of care.

By accepting these terms, you agree to pay all applicable fees for services and treatments. You understand that these fees are subject to change at the practice’s discretion, with prior notice.

• Financial Responsibility

  You agree to be responsible for all costs and expenses, including court costs, attorney fees, and interest, should the practice or Dr. Uddin need to take action to secure an outstanding balance.

• Notice of Non-Coverage of Services

  You understand that this practice is self-pay only and does not accept any commercial, state, or federal insurance plans, including Medicare and Medicaid. You agree to pay for each visit in full, in accordance with the financial policy.

The practice and Dr. Uddin do not guarantee coverage or reimbursement for any treatments, procedures, medications, or lab tests. You acknowledge that you are responsible for all costs, even if your insurance company deems any services not covered, excluded, or medically unnecessary.

Furthermore, you understand that you are advised to maintain full health insurance coverage, as the services provided are not intended to replace it.

You understand that you should not submit any claims for services to Medicare, Medicaid, or any other federal payer, as these claims may not be reimbursed.

If you have any questions, you can contact KC Psychiatry directly.

Thank you,
KC Psychiatry & Primary Care, LLC