• Therapeutic Medical & Psychiatric Services, LLC

    CONTRACT

    Patient Rights & Responsibilities

     

    YOUR RIGHTS AND RESPONSIBILITES AS A CLILENT/PATIENT OF THERAPEUTIC MEDICAL & PSYCHIATRIC SERVICES / DIANE PRIVITOR DAVIS, FNPC, PMHNPBC

    Welcome to the Clinic of Diane Privitor Davis, APRN, FNPC, PMHNPBC/Therapeutic Medical & Psychiatric Services, LLC.

    We hope we can provide you with the kind of support and help you are looking for.

    When you receive services from Therapeutic Medical & Psychiatric Services LLC you have the right to:

    • Receive high quality service
    • Be treated with respect and courtesy
    • Have your information kept private and confidential except as described in the Therapeutic Medical & Psychiatric Services privacy statement
    • Be listened to and have staff work with you to make a plan to address your concerns and needs
    • Receive service in offices that are safe, clean and accessible
    • Get information and support to help you make decisions to improve your situation
    • Be served without discrimination
    • Discuss your service with staff to identify if it is working for you and express and questions or complaints that you may have
    • Request a change of provider if you feel your needs are not adequately being met - this will be done by referring you to another provider of similar status.

    This is what we ask from you:

    • Treat the staff and others at Therapeutic Medical & Psychiatric Services with courtesy and respect.
    • Let Therapeutic Medical & Psychiatric Services know 24 hours before if you are unable to come to an appointment.
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  • Clear
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  • For Office Use Only:

  • Clear
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  • Revised 8/18/17

    By:____________________________

  • Should be Empty: