have been assessed by Beautiful Minds Medical, Inc. for admission into the Intensive Outpatient Program (IOP) and have been informed that I may attend the IOP program. I will be called when authorization from my insurance company has been accomplished and at that time I will be given a start date.
I understand that this is a voluntary program and that I have been notified that my acceptance into the program has been approved. I also understand that the staff at Beautiful Minds Medical, Inc. will be expecting me to attend. If for any reason, I change my mind and do not wish to attend, I will call the program office at (530) 889-8780 prior to my start date and inform them of this decision.
A staff member from Beautiful Minds Medical, Inc. may contact me if I do not call or attend any scheduled session. I also agree to pay a no-show fee of $110.00 if I fail to let staff know that I will not be attending a session.