Call/text: 949-207-6775

Sina Safahieh, M.D. 

Child, Adolescent, and Adult Psychiatrist 

Our Services/Policies 

In order to prevent any misunderstanding concerning your psychiatric care, including contact in between

sessions, cancellation policy, responsibility for payment for services provided, please read the following

information carefully:



EVALUATION AND TREATMENT

First we need to clarify what the problems are and what treatment would be best for you. After the initial

assessment, we will discuss the risks and benefits of treatment options, which may include therapy or

medication treatment, or a combination of both. If you feel it is not possible for us to work together for any

reason, I will do my best to refer you to other mental health clinicians better suited for your needs.



FEES

Initial Evaluation  – 60 to 90 minutes: $500.00


Follow-up Sessions  (With or without medication): 50 minutes: $400.00 25-30 minutes: $200.00



PAYMENTS

Payment for services provided is due at the end of each session (cash, check, credit/debit cards). If your

account has payment overdue for over 60 days, legal means will be considered to secure payment,

including collection agencies or small claims court. There will be a $25.00 service charge for all retuned

checks.



CANCELLATIONS AND NO-SHOW POLICY

Once your appointment is scheduled, you will be expected to pay for it unless you provide at least 24

business hours advance notice of cancellation. If you do not provide at least 24 business hours notice,

or fail to show for a scheduled appointment, you will be responsible for the full cost of the session.

Insurance companies will often not reimburse for missed sessions or sessions cancelled late.



INSURANCE REIMBURSEMENT

I am considered an “out of network provider” for PPO plans. Please be aware that your health insurance

policy is an agreement between you and your insurance company. All charges are your responsibility,

whether or not you have insurance. I will provide you with a statement that can be submitted to your

insurance company. Please find out from your insurance company exactly what mental health benefits

are covered.



CONTACTING ME

All calls to my office number are answered by voice mail. I do check for messages frequently throughout

the day, even on weekends, and return phone calls by the next business day. You are welcome to email

or text me, but I do not check for messages as regularly as I do with voicemail messages, and therefore,

I cannot guarantee that I will respond to email or text messages in a timely manner. Please be aware

that email is not a secure medium. Please contact me with questions or concerns about medication supply.

If you missed or could not make an appointment, you will be given enough medication to last until our next

rescheduled session, usually within 2 weeks.


Please call 911 or go directly to ER with any life-threatening medical or psychiatric emergency 



PATIENT RECORDS

Both the law and the standards of my profession require that I keep appropriate treatment records. You

are entitled to review a copy of the records, unless I believe seeing them would be emotionally

damaging, in which case, I will be happy to provide them to an appropriate mental health professional of

your choice. Because these are professional records, they can be misinterpreted or upsetting, so I

recommend that we review them together so that we can discuss what they contain. I can also prepare

an appropriate summary for review.



CONFIDENTIALITY

Confidentiality is of utmost importance in mental health treatment and is protected by the law. I can only

release information about our work to others with your written permission. For child and adolescent

patients, their trust in me is paramount. Before discussing a sensitive issue with the parent I will first get

the minor’s permission. I generally try to help the child/adolescent to discuss any sensitive matters with

their parents themselves.


There are exceptions to confidentiality where disclosure is required by law. These are:

-Threat of harm to self

-Threat of harm to others

-Inability to care for your basic needs (food, clothing, shelter)

-Indication of possible abuse to a child, elderly person, to disabled person

In the event of any of the above, I may have to contact other parties (ie. family members, state agency,

police, or hospital) in order to protect you or someone else.



PRACTICE STATUS

I share an office suite with other mental health professionals. With regard to your clinical care, I am

completely independent and solely responsible. My clinical records are separately and securely

maintained.