Forms and Information
Before your first appointment:
- Please complete the Adult Intake Form or Adolescent Intake Form with Signature Page.
- Please, review the Patient/Client Agreement and Notice of Privacy Practice.
- Please complete the Credit Card Authorization Agreement, even if you are not planning to use a Credit Card regularly.
On the Signature page (attached to the Intake Form), you confirm that you have taken note of the Agreement and Notice of Privacy Practice. Please, feel free to discuss any questions with me. You will also choose our means of communication and whether or not you will provide me with a release of information to consult with your primary care physician about your health concerns.
Follow-up appointments:
- Please note that cancellations or rescheduling are ONLY possibly MORE THAN 24 HOURS prior to your appointment. If you cancel or reschedule later, it is a missed appointment, and a missed session flat fee will be charged to your account.
- If you have a regular weekly, 2-weekly, or monthly appointment set up, and have missed your appointment, I will expect that you keep your next regularly scheduled appointment unless you cancel it. If you need to miss your regularly scheduled next appointment, you will need to cancel it. After missing a regularly scheduled appointment twice in a row without timely cancellation notice, I will assume that the client is not interested in the regular appointment time any more, and will offer the time to other waiting clients.
To download and complete:
Adult Intake Form
Credit Card Authorization Agreement
If needed, Release of Information
Release of Information
To review:
Psychiatrist Patient/Client Agreement
Notice of Privacy Practice
Use of Email in Communication With My Provider
Your Patient Portal
Once you have received information about your patient portal access (username and initial password), you will be ready to use the patient portal for
- secure messaging about non-urgent concerns
- convenient payments by credit card (make sure to review the most recent account statement first)
- review the specifics of you appointment time from the weekend prior to your appointment
- established clients can use the Login button below. For your convenience another Login is on the Welcome page.
Telemedicine Services
Telemedicine is not appropriate in all situations, but where it is, it is a great way to connect with your provider securely without a trip to the office. People driving a long distance to the office, mothers in the initial months after childbirth, very busy professionals, or those traveling a lot may discuss with me, whether telemedicine services would be possible for them, at least intermittently. I use an online videoconferencing platform that complies with the US health care security and confidentiality standards (HIPAA).
You need a PC or tablet (NOT a smart phone), a Google Chrome, or Firefox browser, best updated. You just paste the link to my online waiting room in the browser. It is always the same. You will need to allow that the software uses your camera and microphone, and then sign in at the time of your appointment. If there are technical difficulties on either side, we connect by phone and decide about the next step. I will always need to know from you, where you are, and how I can reach you in case we get disconnected.
I need you to review and sign the Tele-mental-health Informed Consent Form. Please ask me any questions you may have.
Nowadays most insurances cover telemedicine. Please check with your insurance. whether your plan has this provision.
Before your first appointment:
- Please complete the Adult Intake Form or Adolescent Intake Form with Signature Page.
- Please, review the Patient/Client Agreement and Notice of Privacy Practice.
- Please complete the Credit Card Authorization Agreement, even if you are not planning to use a Credit Card regularly.
On the Signature page (attached to the Intake Form), you confirm that you have taken note of the Agreement and Notice of Privacy Practice. Please, feel free to discuss any questions with me. You will also choose our means of communication and whether or not you will provide me with a release of information to consult with your primary care physician about your health concerns.
Follow-up appointments:
- Please note that cancellations or rescheduling are ONLY possibly MORE THAN 24 HOURS prior to your appointment. If you cancel or reschedule later, it is a missed appointment, and a missed session flat fee will be charged to your account.
- If you have a regular weekly, 2-weekly, or monthly appointment set up, and have missed your appointment, I will expect that you keep your next regularly scheduled appointment unless you cancel it. If you need to miss your regularly scheduled next appointment, you will need to cancel it. After missing a regularly scheduled appointment twice in a row without timely cancellation notice, I will assume that the client is not interested in the regular appointment time any more, and will offer the time to other waiting clients.
To download and complete:
Adult Intake Form
Credit Card Authorization Agreement
If needed, Release of Information
Release of Information
To review:
Psychiatrist Patient/Client Agreement
Notice of Privacy Practice
Use of Email in Communication With My Provider
Your Patient Portal
Once you have received information about your patient portal access (username and initial password), you will be ready to use the patient portal for
- secure messaging about non-urgent concerns
- convenient payments by credit card (make sure to review the most recent account statement first)
- review the specifics of you appointment time from the weekend prior to your appointment
- established clients can use the Login button below. For your convenience another Login is on the Welcome page.
Telemedicine Services
Telemedicine is not appropriate in all situations, but where it is, it is a great way to connect with your provider securely without a trip to the office. People driving a long distance to the office, mothers in the initial months after childbirth, very busy professionals, or those traveling a lot may discuss with me, whether telemedicine services would be possible for them, at least intermittently. I use an online videoconferencing platform that complies with the US health care security and confidentiality standards (HIPAA).
You need a PC or tablet (NOT a smart phone), a Google Chrome, or Firefox browser, best updated. You just paste the link to my online waiting room in the browser. It is always the same. You will need to allow that the software uses your camera and microphone, and then sign in at the time of your appointment. If there are technical difficulties on either side, we connect by phone and decide about the next step. I will always need to know from you, where you are, and how I can reach you in case we get disconnected.
I need you to review and sign the Tele-mental-health Informed Consent Form. Please ask me any questions you may have.
Nowadays most insurances cover telemedicine. Please check with your insurance. whether your plan has this provision.
Frauke C. Schaefer, MD 1709 Legion Road, Suite 225 Chapel Hill, NC 27517
Tel (919) 357-7204 Fax (919) 929-7648 FraukeSchaeferMD@gmail.com