The goal of Neuro Nudge Psychiatry, PLLC is to provide the highest quality care for adults and children who are experiencing mental health concerns. I will discuss with you the nature of the illness, the reason for the medication or supplement, the likelihood of improving with and without medication or supplements.
About The Practice
The goal of Neuro Nudge Psychiatry is to provide the highest quality care for adults and children experiencing mental health concerns. Your provider provides psychiatric evaluation, medication management, and care coordination. The providers evaluates, diagnoses, and recommends treatment that may include medications, therapy referrals, and follow‑up care. The provider will communicate with you throughout your care and support your treatment goals.
What is a Psychiatric Clinic?
A psychiatric clinic is a medical practice where psychiatrists (MD/DO), Physician Assistant (PA), and psychiatric nurse practitioners (PMHNPs) evaluate mental health conditions, provide psychotherapy or referrals, and prescribe and manage medications when indicated.
Services Rendered
Psychiatric Evaluation Initial evaluation typically lasts 90 minutes. The clinician will gather history, symptoms, and relevant records to make a diagnosis and recommend a treatment plan. Additional visits may be scheduled if more time is needed.
Scope of Practice:
Neuro Nudge Psychiatry provides psychiatric evaluation, medication management, care coordination, and referrals. The clinic does not provide forensic evaluations or forensic services such as custody evaluations, assessments recommended by probation, competency evaluations, or ability to stand trial. Neuro Nudge Psychiatry does not provide primary medical care; referrals will be offered if needed.
Medication Management and Informed Consent
If medication management is indicated, your clinician will explain the nature of your condition and the reason for the recommended medication. Your provider will discuss the expected benefits, reasonable alternatives (including non‑drug options), and the likely course with and without medication. You will be informed of the medication name, initial dose, maintenance dose and dose range, common and serious side effects (including any black box warnings), important drug interactions, and any known long‑term risks. The provider will explain monitoring requirements (labs, follow‑up visits), and the risks of abrupt discontinuation and how to taper safely. You have the right to ask questions and to refuse medication; your decision will be documented. Consent may be documented by written signature, electronic signature/portal acknowledgement, or documented verbal consent during a telehealth visit.
Special Notes
Controlled substances: Prescribing of controlled medications (e.g., benzodiazepines, stimulants) follows federal and Texas rules. These medications may require in‑person visits, checks of the Texas Prescription Monitoring Program (PMP), urine drug testing, and more frequent follow‑up. Early refills may be denied.
Monitoring and labs: Some medications require baseline and periodic laboratory tests, ECGs, or other monitoring. Your clinician will explain what tests are needed and how often.
Pregnancy, breastfeeding, and fertility: If you are pregnant, planning pregnancy, or breastfeeding, tell your clinician before starting or changing medications; some medications carry special risks and require alternative treatment or additional monitoring.
Minors and guardians: For patients under the age of consent, a parent or legal guardian must provide consent; clinicians will seek the minor’s assent when appropriate and will explain confidentiality limits.
Drug interactions and supplements: Tell us about all prescription drugs, over‑the‑counter medicines, vitamins, and herbal supplements you take (including alcohol and cannabis). Some combinations can be harmful.
Driving and safety: Some medications may impair alertness, coordination, or judgment. Do not drive or operate heavy machinery until you know how a medication affects you.
Withdrawal and tapering: Stopping some medications suddenly can cause withdrawal or rebound symptoms. Your clinician will explain safe tapering procedures when discontinuing medications.
Off‑label use and alternatives: Some medications may be prescribed “off‑label.” Your clinician will explain the rationale and alternatives.
· How to report problems: For urgent medication side effects (difficulty breathing, swelling, severe rash, chest pain, seizures, suicidal thoughts), call 911 or go to the nearest emergency department. For non‑urgent concerns, message the clinic portal or call during business hours.
· Refill policy and pharmacy: Provide your preferred pharmacy and allow at least 72 hours for routine refills; controlled substances may require 7 days’ notice and a scheduled visit.
Documentation and revocation: All medication discussions and consents are documented in your medical record. You may withdraw consent for electronic communications at any time; medication decisions already made will be documented and managed per clinical judgment.
Therapy and Referrals
Neuro Nudge Psychiatry, PLLC believes in the whole client approach and provides therapy referral as requested by our clients. The appointments are booked as an initial psychiatric evaluation, and upon mutual decision making, together we will determine your next best steps-whether it be therapy only, medication management and therapy, or a referral to a therapist or psychologist. Your clinician will provide referrals to therapists and coordinate care when appropriate. The clinician does not provide specialty therapies in‑house (e.g., EMDR, DBT) but will assist in finding appropriate providers.
Neuropsychological Testing
Neuro Nudge Psychiatry, PLLC provides neuropsychological testing for Autism Spectrum Disorder (ASD). If you request testing for ASD, you will first have an initial psychiatric evaluation with an ADOS‑2 certified clinician. If the clinician determines you or your child meets eligibility criteria for an ADOS‑2 evaluation, you will be scheduled for a one‑hour ADOS‑2 assessment. Please allow several weeks for completion of the official written report. After the report is completed, you will be scheduled for a follow‑up appointment to review results and plan next steps. This service is not always covered by insurance and may carry a fee of $750.00 in addition to the initial psychiatric evaluation fee. Payment is due Headway policy; please contact Headway for scheduling and payment arrangements. The ADOS-2 Assessment is one component of diagnostic evaluation. Final diagnostic impressions may incorporate clinical interview, developmental history, collateral information, and other testing as appropriate.
Electronic Communication and Remote Consent (Six Recommended Elements)
When you register and use our portal or encrypted email, you are asked to consent to the following operational guidelines. This general consent covers how you may request medications and how your clinician may provide medication‑related information and obtain consent remotely. It does not replace medication‑specific informed consent for each new medication.
Methods Permitted
We may communicate with you using the secure patient portal, encrypted HIPAA‑compliant email, and telehealth (video/phone). Portal messaging is the preferred method. We will not use standard (unencrypted) email for protected health information.
You may request medication refills or ask medication questions via the secure portal, Headway messaging, or encrypted text only.
Information to Be Provided Remotely
For any new medication or medication change, the clinician will provide: diagnosis/purpose, expected benefits, common and serious risks (including black‑box warnings when applicable), alternatives (including non‑pharmacologic), likely course and monitoring plan, and consequences of declining treatment.
How Consent Is Obtained and Documented
Medication‑specific consent must be obtained before initiating a new medication. Consent may be:
Written via secure portal message or encrypted email reply stating clear affirmative consent; or
Electronic signature on a clinic consent form; or
Verbal during a telehealth visit (documented in the clinical note).
All remote consents will be uploaded and retained in the medical record. The clinician will document the method, date/time, and content of the consent discussion.
Timing and Response Expectations
Allow 72 hours (3 business days) for routine medication refill requests. Your provider does not process refill requests on weekends. If you have an urgent need outside business hours, go to the nearest emergency department.
For controlled substances, follow the clinic’s controlled‑substance policy (see below); additional time and an in‑person visit may be required.
Limitations and Safety Rules
Remote consent and prescribing are subject to clinical judgment and legal/regulatory limits. The clinician may require an in‑person visit when clinically necessary (e.g., complex cases, safety concerns, or when federal/state rules require it).
Controlled substances (including benzodiazepines and stimulants) may require in‑person evaluation or additional monitoring per federal DEA and Texas rules. Urine drug testing, prescription monitoring program checks, and scheduled follow‑up visits may be required.
Patient Responsibilities and Privacy
You must provide accurate contact and pharmacy information and keep your portal account secure. You are responsible for reading medication information provided and asking questions before consenting.
All portal and encrypted email communications become part of your medical record. We use HIPAA‑compliant systems; however, messages transmitted over public networks may carry residual risk. Avoid sending emergency messages via portal/email.
Medication Prescribing and Refill Policy
E‑Prescribing: Prescriptions are sent electronically to your chosen pharmacy. Provide current pharmacy name and address.
Refills: Request refills at least 72 hours before running out. If refills remain, contact your pharmacy first. We do not process refill requests on weekends. For controlled substances, request at least 4 days before running out and ensure a scheduled follow‑up appointment.
Controlled Substances: Neuro Nudge Psychiatry verifies controlled‑substance prescriptions through the Texas Prescription Monitoring Program (PMP). Your provider may require urine drug screens or other monitoring. Early refills may be denied. Benzodiazepines and other controlled medications are reviewed at each visit.
If you are prescribed a controlled substance, you must request refills through the patient portal 4 days before you run out of medication. This allows adequate time for review of your chart, Prescription Monitoring Program (PMP) checks, and any required follow‑up.
Refills for controlled substances cannot be guaranteed without a scheduled follow‑up appointment. You must have an upcoming appointment on the calendar to receive any controlled‑substance refill.
Urine drug screening may be required at the provider’s discretion. These screenings help ensure safe prescribing and compliance with federal and state regulations.
All benzodiazepine prescriptions (such as Xanax, Ativan, and Clonazepam) must be taken exactly as prescribed. The risks, benefits, and appropriateness of continued benzodiazepine use will be reviewed with you at each appointment. Long‑term or frequent use may require additional monitoring, taper planning, or alternative treatment options.
Informed Consent for Medications (Medication‑Specific)
Before starting any new medication, you will receive medication‑specific information and be asked to provide consent. The clinician will document:
Medication name, dose, and titration plan
Purpose and expected benefits
Common and serious side effects and black‑box warnings (if any)
Alternatives and rationale for choice
Monitoring plan (labs, follow‑up schedule)
How to report side effects and emergency instructions
Patient’s explicit consent (method and date/time) and any questions asked
Confidentiality and HIPAA
The security of your sensitive information is extremely important. Neuro Nudge is bound by federal and state laws, including HIPAA and Texas HB 300, to protect the confidentiality of your mental health information. Mental health records are considered specially protected under Texas law.
Neuro Nudge Psychiatry, PLLC may use or disclose your information for treatment, payment, and healthcare operations without written authorization, as permitted by HIPAA. This includes basic information required by your insurance company for prior authorization or billing.
Any other disclosure of your treatment information will require your explicit written authorization.
There are specific situations in which confidentiality cannot be maintained and disclosure is required by law:
Threats to others: If you make a serious threat toward another person, we are required to take protective action. This may include notifying the potential victim, contacting law enforcement, and arranging hospitalization.
Imminent danger to yourself: If you are at imminent risk of harming yourself, we must take steps to ensure your safety. This may include seeking emergency hospitalization and involving family or trusted support.
Abuse, neglect, or trafficking: If there is concern for physical abuse, sexual abuse, trafficking, or neglect involving a child, elderly adult, or vulnerable adult, we are required to report this to Child Protective Services (CPS) or Adult Protective Services (APS).
Court orders: You have the right to decline our involvement in legal proceedings. However, in rare circumstances a judge may issue a court order requiring us to testify regarding your emotional or cognitive condition.
Unsafe driving due to cognitive impairment: If a dementing illness, epilepsy, or other cognitive condition significantly impairs your ability to drive safely, we are required to report this to the Department of Motor Vehicles (DMV).
These situations are uncommon in outpatient practice. If any arise, we will make every effort to discuss the situation with you before taking action. In unusual circumstances, we may consult with other professionals who specialize in these matters; when doing so, your identity will not be disclosed.
Paperwork
For each follow‑up appointment, you will be asked to complete a Patient Health Questionnaire (PHQ‑9) and Generalized Anxiety Disorder 7-item scale (GAD-7). These forms will be uploaded to your portal prior to each visit and must be completed before your appointment time.
If you are requesting FMLA, disability documentation, workplace accommodation forms, or other administrative paperwork, the following requirements apply:
A minimum of three appointments is required before any disability or FMLA paperwork can be completed.
All disability/FMLA paperwork requires a dedicated appointment with your provider to review the request, assess eligibility, and complete the necessary documentation.
Paperwork cannot be completed outside of an appointment, as clinical evaluation is required to ensure accuracy and compliance with legal and medical standards.
There may be a fee associated with paperwork.
Cancellation Policy
Once your appointment is scheduled, you are required to provide at least 24 business hours’ notice if you need to cancel or reschedule. Business hours are defined as Monday through Friday, 8:00 AM to 5:00 PM.
Because weekends and after‑hours periods do not count toward business‑hour notice, the following applies:
If you have an appointment on Monday at 4:00 PM, you must cancel no later than 4:00 PM on the Friday before to avoid a fee.
If you cancel with less than 24- business hours’ notice, or fail to attend your scheduled appointment, you will be charged a $75.00 late‑cancellation fee.
These fees cannot be billed to insurance and are the patient’s responsibility.
Neuro Nudge Psychiatry values your time and the time of all our patients. If you arrive 15 minutes or more past your scheduled appointment time, I will determine whether you can still be seen. If you cannot be seen due to lateness, you will need to reschedule as soon as possible.
Labs
Laboratory testing may be ordered periodically to rule out underlying medical conditions, monitor overall health, and assess for potential medication side effects. Certain psychiatric medications require routine lab monitoring to ensure safe and effective treatment.
It is your responsibility to complete all the lab work ordered before your next scheduled appointment or as otherwise directed by your provider. Failure to complete required labs may delay medication refills or continuation of treatment until results are available.
If any critical or urgent lab values are identified, your provider will send a message through your patient portal to schedule an appointment to review the results promptly. All other lab results will be discussed on your next scheduled visit.
Some abnormal lab values may require referral to a specialist or your primary care provider for further evaluation or treatment. Your provider will discuss these recommendations with you and assist in coordinating appropriate follow‑up when needed.
Messaging and Response Times
Portal messages: Preferred; allow 1–2 business days for a response.
Encrypted email: Allowed for non‑urgent medication requests if you consent to this method. We will not use standard email for PHI.
Phone calls: For urgent clinical concerns during business hours call the office. For emergencies after hours call 911 or go to the nearest ER.
Suicide Risk Assessment and Response Protocol
Neuro Nudge Psychiatry, PLLC is committed to providing safe, evidence‑based care for patients experiencing suicidal thoughts or behaviors. If you report suicidal ideation, intent, or concerning symptoms, your clinician will follow a structured assessment and response protocol.
Assessment
Your clinician will complete a suicide‑risk evaluation that may include:
Review of current thoughts, intent, plan, means, and protective factors
Screening tools such as the PHQ‑9, GAD‑7, or a structured suicide‑risk instrument when indicated
Review of recent stressors, substance use, medical conditions, and history of self‑harm
Collateral information when appropriate and permitted by law
Safety Planning
If risk is identified, your clinician will work with you to create a personalized safety plan. This may include:
Identifying warning signs
Listing coping strategies and crisis resources
Identifying supportive people, you can contact
Removing or securing lethal means when appropriate
Scheduling follow‑up appointments to monitor safety
Follow‑Up and Monitoring
If you are experiencing suicidal thoughts but are not at imminent risk:
Your clinician may increase visit frequency
You may be asked to complete additional check‑ins through the patient portal
Medication adjustments or therapy referrals may be recommended
You may be asked to involve supportive family or friends if appropriate.
