Card on File Policy

Skycloud Mental Health requires that a valid credit card be on file. By acknowledging below, you, to agree client or
responsible party for client, acknowledge that you understand and agree that:

You are an authorized user of any credit card information you provide to Skycloud Mental Health.

You will notify Skycloud Mental Health if your card becomes invalid, lost, stolen or otherwise needs to be removed from the
system.

All payment for services rendered are due at the time of the appointment.

Self-pay clients will pay $395.00 for the initial psychiatric evaluation. If the initial psychiatric evaluation goes over 60
minutes, you may be charged an additional $97.50 for every 15 minutes over the 60 minutes at the discretion of the client’s
provider. Follow appointments vary from 15 minutes to 30 minutes with a cost range of $195 for up to 30 minutes. It is your responsibility to be aware of the cost of the appointment prior to the services being rendered. Self-pay
patients are expected to pay the full amount of the appointment cost at the time of booking.

A fee of $85 is charged for the completion of forms including the following but not limited to: Disability, FMLA, LOA, and letters. Brief forms that are completed during an appointment may be eligible for a fee waiver. Payment of the form fee may be requested prior to the release of the requested forms.

There are no refunds for services rendered. You are financially responsible for all charges, whether or not: a. we
decided to proceed with treatment b. treatment is successful, for which there cannot be any guarantee.

If Skycloud Mental Health is in network with your insurance panel, you agree that we will process claims directly with your insurance company. You are responsible for the amount not covered by insurance. This is based on your individual
insurance plan and not determined by Skycloud Mental Health. Medicare/Medicaid plans are not accepted. Clients
with Medicare insurance cannot be charged as self-pay due to federal regulations. 

If client fails to cancel within 24 hours of appointment start time or does not present for appointment as scheduled, our listed no-show rates will be charged. This is considered non-refundable.

There is a 3% finance charge each month for balances more than 30 days past due. If you have not paid outstanding fees in full within 90 days, your account will be turned over to a collection agency. If your account is sent to a collection agency, they will report your past due status to a Credit Reporting Agency and you will be responsible for their fees.

There is a $30 fee for returned checks (which will also result in your credit card automatically being run for the balance due) and for credit card charge-backs that are unsubstantiated.

    Holistic Psychiatric Treatment
    at Home in OR, WA, UT, and MN

    Getting better starts now,
    with Skycloud by your side

    Get Started

    Do you prefer to register online or by phone?

    The following questions will match you with the provider best suited to your needs. Are you the patient?

    The potential patient, or their parent/guardian, must fill out this form. Identification will be requested during the process. If they are not available, please direct the potential patient to this page at a later time. Health care providers can find referral information here.

    We are taking patients ages 13-17 with certain specified insurance panels in OR and WA, and patients 16-17 with a referral in UT. “You” in the following slides refers to the potential patient.

    Are you seeking psychotherapy, medication management, or another evaluation type?

    Our psychotherapy caseload is full. Click here to learn more about psychiatric evaluations, which can help you determine a treatment plan. Call us at 503-694-3391 or email admin@skycloudhealth.com with any questions.

    Our psychotherapy caseload is full. Click here to learn more about psychiatric evaluations, which can help you determine a treatment plan. Call us at 503-694-3391 or email admin@skycloudhealth.com with any questions.

    Limitations of Skycloud:

    • – We do not offer emotional support animal letters.
    • – We do not offer evaluations for disability or legal reasons.
    • – We do not accept Medicare or Medicaid.
    • – We do not provide work or academic accommodations. We can provide a diagnosis letter in the context of ongoing psychiatric care.
    Resources

    Have you attempted suicide in the past?

    When was your most recent suicide attempt?

    Unfortunately we do not have clinicians who are able to treat you via telehealth at this time. Please contact clinic at (503) 694-3381 with questions and check our list of resources.

    Have you ever been hospitalized in a psychiatric unit or stayed in a residential mental health facility?

    When was your most recent hospitalization or stay in a residential mental health facility?

    Where do you reside?

    We are only offering services in Oregon, Washington, Utah, Arizona, and Minnesota at this time.

    Are you currently prescribed a stimulant (e.g. Adderall, Ritalin) or benzodiazepine (e.g. Ativan, Xanax) and seeking to continue it?

    Are you currently prescribed a stimulant (e.g. Adderall, Ritalin) or benzodiazepine (e.g. Ativan, Xanax) and seeking to continue it?

    Are you currently prescribed a stimulant (e.g. Adderall, Ritalin) or benzodiazepine (e.g. Ativan, Xanax) and seeking to continue it?

    Are you currently prescribed a stimulant (e.g. Adderall, Ritalin) or benzodiazepine (e.g. Ativan, Xanax) and seeking to continue it?

    We prescribe controlled substance medications (i.e. stimulants, benzodiazepines) only to patients in OR and WA with a required minimum once yearly in-office visit in Clackamas, OR when clinically appropriate (please view our stimulant policy). It may be helpful to note that in our practice, we rarely use benzodiazepines (e.g. Xanax, Ativan, Klonopin). Contact admin@skycloudhealth.com with questions.

    In-office visits are required once a year in Springfield, OR or Clackamas, OR for patients who are prescribed controlled substances. Click “Okay” to continue.

    We prescribe controlled substance medications (i.e. stimulants, benzodiazepines) only to patients in OR and WA with a required minimum once yearly in-office visit in Clackamas, OR when clinically appropriate (please view our stimulant policy). It may be helpful to note that in our practice, we rarely use benzodiazepines (e.g. Xanax, Ativan, Klonopin). Contact admin@skycloudhealth.com with questions.

    In-office visits are required once a year in Springfield, OR or Clackamas, OR for patients who are prescribed controlled substances. Click “Okay” to continue.

     

     

    We do not prescribe stimulant, benzodiazepines, Suboxone, or other controlled substances in Minnesota. If you would still like to schedule, click Okay. To see other Resources, click “Resources.”

    We do not prescribe stimulant, benzodiazepines, Suboxone, or other controlled substances in Utah. If you would still like to schedule, click Okay. To see other Resources, click “Resources.”

    Which insurance plan do you have?

    Which insurance plan do you have?

    Which insurance plan do you have?

    Which insurance plan do you have?

    Which insurance plan do you have?

    Which insurance plan do you have?

    If your insurance was not listed, we may not be in your network. Please email billing@skycloudhealth.com to verify.

    If your insurance was not listed, we may not be in your network. Please email billing@skycloudhealth.com to verify.

    How old are you?

    We do not have providers serving people under 18 at this time who accept your insurance. Email us for temporary self-pay options while our pediatric providers are in the credentialing process. Here is a list of resources.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    How old are you?

    Currently, our providers who accept your insurance take patients ages 18+ or 16-17 with a referral. Providers in our practice who do not accept your insurance accept self-pay patients and are in the credentialing process with your insurance panel. Contact admin@skycloudhealth.com if you have a referral or would like to self-pay temporarily.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    How old are you?

    We do not have providers serving people under the age of 13 at this time. Here is a list of resources.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    How old are you?

    We do not have providers serving people under the age of 13 at this time. Here is a list of resources.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    How old are you?

    We do not have providers serving people under the age of 13 at this time. Here is a list of resources.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    Our provider is in process of panelling with your insurance. You can see him at a discounted self pay rate until he is contracted. Click below to schedule.

    Resources

    Registration forms must be completed within 24 hours of booking or appointment will be cancelled. Forms take 15-20 minutes to complete. Please have your payment method, state ID and insurance card available.

    We offer a limited amount of in-office intake appointments in Clackamas, OR (Tuesdays) and Springfield, OR (Thursdays). If you do not see this as an option, you can register as a patient and then email admin@skycloudhealth.com to change your appointment.

    *All times are in Pacific Standard Time (PST).

    Schedule Appointment

    Registration forms must be completed within 24 hours of booking or appointment will be cancelled. Forms take 15-20 minutes to complete. Please have your payment method, state ID and insurance card available.

    We offer a limited amount of in-office intake appointments in Clackamas, OR (Tuesdays) and Springfield, OR (Thursdays). If you do not see this as an option, you can register as a patient and then email admin@skycloudhealth.com to change your appointment.

    *Note: All times are in Pacific Standard Time (PST).

    Registration forms must be completed within 24 hours of booking or appointment will be cancelled. Forms take 15-20 minutes to complete. Please have your payment method, state ID and insurance card available.

    We offer a limited amount of in-office intake appointments in Clackamas, OR (Tuesdays) and Springfield, OR (Thursdays). If you do not see this as an option, you can register as a patient and then email admin@skycloudhealth.com to change your appointment.

    *Note: All times are in Pacific Standard Time (PST).

    Dose/Med

    Our providers will review your submission to determine if we are a good fit for your needs. Please submit the following required information for the potential patient (yourself or your child): insurance, age, current medications names and dosages. If the potential patient is taking a benzodiazepine, specify if they are looking to taper off of the medication. If the potential patient is a minor, please specify whether or not they have a history of self-harm. *It may be helpful to note that in our practice, we rarely use benzodiazepines (e.g., Ativan, Xanax, Klonopin).

    Name(Required)
    Name(Required)

    Med/Dose

    Our providers will review your submission to determine if we are a good fit for your needs. Please submit the following required information for the potential patient (yourself or your child): insurance, age, current medications names and dosages. If the potential patient is taking a benzodiazepine, specify if they are looking to taper off of the medication. If the potential patient is a minor, please specify whether or not they have a history of self-harm. *It may be helpful to note that in our practice, we rarely use benzodiazepines (e.g., Ativan, Xanax, Klonopin).

    Name(Required)
    Name(Required)

    Are you currently prescribed a stimulant (e.g. Adderall, Ritalin) or benzodiazepine (e.g. Ativan, Xanax) and seeking to continue it?

    We do not prescribe stimulant, benzodiazepines, Suboxone, or other controlled substances in Arizona. If you would still like to schedule, click Okay. To see other Resources, click “Resources.”

    Which insurance plan do you have?

    If your insurance was not listed, we may not be in your network. Please email billing@skycloudhealth.com to verify.

    We are accepting self-pay patients for psychotherapy in Oregon and Utah. Our provider is in process of credentialing with several insurances. We have a waitlist for clients in Washington.

     

    Resources

    Psychotherapy Consultation (OR and UT)

    We are accepting self-pay patients for psychotherapy in Oregon and Utah. Our provider, Nat Day LCSW, is in process of credentialing with several insurance panels - Cigna, Aetna, PacificSource, BCBS, and Moda. Please provide your contact information for a 15 minute free consultation phone call.

    Name(Required)

    Psychotherapy Waitlist

    Our psychotherapy waitlist is open for patients located in Oregon and Washington with Cigna, Aetna, PacificSource, BCBS, and Moda, and self-pay pay sources only. Our psychotherapy providers treat ages 18-64. This waitlist is currently 6-12 months out, depending on age, state and insurance. Please provide the information requested below. Note: do not use this form in an emergency.

    Name(Required)
    Name(Required)

    Los formularios de registración deben completarse dentro de las 24 horas posteriores a la reserva o la cita será cancelada. Los formularios tardan entre 15 y 20 minutos en completarse. Tenga a mano su método de pago, identificación estatal y tarjeta de seguro médico.

    *Todos los horarios están en hora estándar del Pacífico (PST).

    Proceed with online registration or by phone?

    Phone Number: (503) 694-3381

    Phone Hours: 3:00pm-6:30pm (PT) TWTh / 11am-2pm (PT) Sat and Sun

    Phone Registration

    This is not a guarantee of treatment. You can call our office number (503) 694-3381 extension 2 to register over the phone during the hours listed below.

    Must be a legal guardian of the potential patient.

    Thanks for submitting this form! We will contact you during the specified times.

    How old are you?

    We do not have providers serving people under the age of 13 at this time. Here is a list of resources.

    Due to federal laws that prevent us from seeing patients who are qualified for Medicare as self-pay patients without opting out of Medicare, we are unable to see patients who are over 65 at this time. Here is a list of resources.

    Registration forms must be completed within 24 hours of booking or appointment will be cancelled. Forms take 15-20 minutes to complete. Please have your payment method, state ID and insurance card available.

    We offer a limited amount of in-office intake appointments in Clackamas, OR (Tuesdays). If you do not see this as an option, you can register as a patient and then email admin@skycloudhealth.com to change your appointment.

    *Note: All times are in Pacific Standard Time (PST).

    Your information is kept confidential and helps us ensure we can provide you with care. Assistance: admin@skycloudhealth.com

    If you are in a mental health crisis, do not use this form, call 988.