HIPAA Form Notice of Information

 

This “Notice of Information/Privacy Practices” is used to inform website visitors regarding our policies with the collection, use, and disclosure of Personal Information if anyone decided to use our Service.

If you choose to use our Service, then you agree to the collection and use of information in relation with this policy. The Personal Information that we collect are used for providing and improving the Service. We will not use or share your information with anyone except as described in this Privacy Policy.

Information Collection and Use

For a better experience while using our Service, we may require you to provide us with certain personally identifiable information, including but not limited to your name, phone number, and postal address. The information that we collect will be used to contact or identify you.

Log Data

We want to inform you that whenever you visit our Service, we collect information that your browser sends to us that is called Log Data. This Log Data may include information such as your computer’s Internet Protocol (“IP”) address, browser version, pages of our Service that you visit, the time and date of your visit, the time spent on those pages, and other statistics.

 

Cookies

Cookies are files with small amount of data that is commonly used an anonymous unique identifier. These are sent to your browser from the website that you visit and are stored on your computer’s hard drive.

Our website uses these “cookies” to collection information and to improve our Service. You have the option to either accept or refuse these cookies, and know when a cookie is being sent to your computer. If you choose to refuse our cookies, you may not be able to use some portions of our Service.

Service Providers

We may employ third-party companies and individuals due to the following reasons:

To facilitate our Service;

To provide the Service on our behalf;

To perform Service-related services; or

To assist us in analyzing how our Service is used.

We want to inform our Service users that these third parties have access to your Personal Information. The reason is to perform the tasks assigned to them on our behalf. However, they are obligated not to disclose or use the information for any other purpose.

Security

We value your trust in providing us your Personal Information, thus we are striving to use commercially acceptable means of protecting it. But remember that no method of transmission over the internet, or method of electronic storage is 100% secure and reliable, and we cannot guarantee its absolute security.

Links to Other Sites

Our Service may contain links to other sites. If you click on a third-party link, you will be directed to that site. Note that these external sites are not operated by us. Therefore, we strongly advise you to review the Privacy Policy of these websites. We have no control over, and assume no responsibility for the content, privacy policies, or practices of any third-party sites or services.

Changes to This Privacy Policy

We may update our Privacy Policy from time to time. Thus, we advise you to review this page periodically for any changes. We will notify you of any changes by posting the new Privacy Policy on this page. These changes are effective immediately, after they are posted on this page.

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

    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. Patients in OR, WA and UT can join our waitlist by clicking the button below.

    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 evaluations for disability or legal reasons.
    • – We do not accept Medicare or Medicaid.
    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, New Mexico, 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 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, WA and UT 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 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.”

    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?

    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). 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). 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 PacificSource, Aetna and self-pay patients for psychotherapy in Oregon and Utah. Our provider, Nat Day LCSW, is also in process of credentialing with other insurance panels - Cigna, 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, Washington, and Utah 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

    Register below for a phone call, or call our office number (503) 694-3381 ext. 2 to register. Please only request for a phone call for yourself.

    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).

    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.

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

    Schedule Appointment

    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 New Mexico. 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.

    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.

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

    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.

    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).

    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.

    *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). 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).

    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.

    *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). 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).

    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.

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

    We prescribe controlled substance medications (i.e. stimulants, benzodiazepines) to patients in UT with a required minimum once yearly in-office visit near Salt Lake City, UT 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 near Salt Lake City, UT for patients who are prescribed controlled substances. Click “Okay” to continue.

    Which insurance plan do you have?

    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.

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

    Dose/Med (UT)

    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)

    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?

    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.

    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.

    *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.

    *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.

    *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.

    *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.