www.e-psychiatry.com
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216.240.177.58
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Submitted URL: http://email.e-psychiatry.co/c/eJxNjUEKwyAURE8Td5Gvxh-7cBEo3QV6BaM_saWNwVhCbl-7K7zFzMDMkBXYK4MKAVmwTuNPPKwEqUAIFADYSS6c0l5cZg...
Effective URL: https://www.e-psychiatry.com/contact-us/
Submission: On January 17 via manual from US — Scanned from DE
Effective URL: https://www.e-psychiatry.com/contact-us/
Submission: On January 17 via manual from US — Scanned from DE
Form analysis 4 forms found in the DOM
Name: contact-form — POST
<form name="contact-form" id="contact_form" method="post">
<div class="form-group">
<label>Department</label>
<select class="form-control" placeholder="Select a department" name="department">
<option value="">Choose a department</option>
<option value="sales">Sales</option>
<option value="provider_relation">Provider Relations</option>
<!-- <option value="technology">Technology</option>-->
<option value="customer_service">Customer Service</option>
<option value="it">IT</option>
</select>
</div>
<div class="form-group">
<label>Name</label>
<input type="text" name="name" id="" class="form-control">
</div>
<div class="form-group">
<label>Email</label>
<input type="text" name="email" id="" class="form-control">
</div>
<div class="form-group">
<label>Phone Number</label>
<input type="text" name="phn_no" id="" class="form-control">
</div>
<div class="form-group">
<label>Comment</label>
<textarea name="comment" id="" class="form-control"></textarea>
</div>
<div class="form-group">
<div class="g-recaptcha" data-sitekey="6LcM18EUAAAAAKqi4NQ0LlK5YpxvKzGVLMyQFV8e">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LcM18EUAAAAAKqi4NQ0LlK5YpxvKzGVLMyQFV8e&co=aHR0cHM6Ly93d3cuZS1wc3ljaGlhdHJ5LmNvbTo0NDM.&hl=de&v=u35fw2Dx4G0WsO6SztVYg4cV&size=normal&cb=osku5yrwe7qe"
width="304" height="78" role="presentation" name="a-dt4ts5w3ws2b" frameborder="0" scrolling="no" sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe>
</div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div>
<input type="hidden" name="recaptcha_response_field" value="manual_challenge">
<div class="captcha_error">
<!-- <p class="error">Please fill captcha</p> -->
</div>
</div>
<div class="form-group submit_contact_btn">
<input type="submit" name="" id="contact_btn" class="blue_btn" value="Send">
</div>
</form>Name: recommend_friends_form —
<form name="recommend_friends_form" id="recommend_friends_form" action="">
<div class="no_provider">
<div class="thankU">
<h2 id="recommend_friends_message">It’s time for your session with doctor – click here to begin</h2>
</div>
<div class="thankBtn">
<div class="thank-btns">
<a href="javascript:void(0);" title="Join Session" class="blue_btn radius3 trans join_session_button">Join Session</a>
</div>
</div>
</div>
</form>Name: recommend_friends_form —
<form name="recommend_friends_form" id="recommend_friends_form" action="">
<div class="no_provider">
<div class="thankU">
<h2 id="recommend_friends_message">Thank you for recommending e-Psychiatry to your friend or colleague. Please provide the brief information requested below, and “Send” to invite others to e-Psychiatry.com.</h2>
</div>
<div class="pop_cont_outer">
<p>
<input class="check_box" type="radio" name="share_name" value="share_name" id="share_name"><span class="check_box_cont">Share my name with the people who received my recommendation.</span>
</p>
<p class="share_my_name">
<input class="check_box" type="radio" name="share_name" value="no_share" id="no_share"><span class="check_box_cont">Don't share my name with the people who receive my recommendation (anonymous recommendation).</span>
</p>
<span class="share_name_error error-name"></span>
</div>
<div class="thankU">
<div class="col-sm-12 bor_add_ptrovder recomend_pop_up">
<div class="row">
<div id="invite_type_options">
<input type="radio" name="invite_type" class="invite_not_anonymous" value="not_anonymous"> Let others know I invited them to e-Psychiatry<br>
<input type="radio" name="invite_type" class="invite_anonymous" value="anonymous"> Don't let others know I invited them to e-Psychiatry <span class="invite_type_error_msg"></span>
</div>
<table>
<tbody>
<tr>
<th>Title</th>
<th>First Name</th>
<th>Last Name</th>
<th>Email</th>
<th> </th>
</tr>
<tr class="provider_row">
<td>
<select name="provider_title[]" class="provider_title" autocomplete="off">
<option value="">Select Title</option>
<option value="Dr." name="pro_title[]">Dr.</option>
<option value="Mr." name="pro_title[]">Mr.</option>
<option value="Ms." name="pro_title[]">Ms.</option>
</select>
</td>
<td> <input type="text" name="fname[]" class="fname" id="fname" value=""></td>
<td><input type="text" name="lname[]" class="lname" id="lname" value=""></td>
<td> <input type="text" name="email[]" class="email" id="email" value=""></td>
<td> </td>
</tr>
<tr class="">
<td> </td>
<td> </td>
<td> </td>
<td> <a class="add_prov blue_btn" style="color:#fff;" href="javascript:void(0);" id="add_friend1">Add More</a></td>
<td> </td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<div class="thankBtn">
<div class="thank-btns">
<input type="hidden" name="method" value="recommend_friends">
<a href="javascript:void(0);" title="Send" type="submit" id="recommend_friends_submit" class="blue_btn radius3 trans">Send</a>
<a href="javascript:void(0);" title="Cancel" id="close_recommend_friends_modal" class="orange_btn radius3 trans">Cancel</a>
</div>
</div>
</div>
</form>Name: share_form —
<form name="share_form" id="share_form" action="">
<div class="no_provider">
<div class="thankU">
<div class="col-sm-12 bor_add_ptrovder recomend_pop_up">
<div class="row">
<!--<table>
<tr>
<th>First Name</th>
<th>Last Name</th>
<th>Email</th>
<th> </th>
</tr>
<tr >
<td> <input type="text" name="fname" id="share_fname" value=""/><span class="fname_error" style="color:red; font-size:14px;"></span></td>
<td><input type="text" name="lname" id="share_lname" value=""/><span class="lname_error" style="color:red; font-size:14px;"></span></td>
<td> <input type="text" name="email" id="share_email" value=""/><span class="email_error" style="color:red; font-size:14px;"></span></td>
<td> </td>
</tr>
</table>-->
<div class="pop_filds">
<p>First Name</p>
<div class="fild_name">
<input type="text" name="fname" id="share_fname" value="">
<span class="fname_error" style="color:red; font-size:14px;"></span>
</div>
</div>
<div class="pop_filds">
<p>Last Name</p>
<div class="fild_name">
<input type="text" name="lname" id="share_lname" value="">
<span class="lname_error" style="color:red; font-size:14px;"></span>
</div>
</div>
<div class="pop_filds">
<p>Email</p>
<div class="fild_name">
<input type="text" name="email" id="share_email" value="">
<span class="email_error" style="color:red; font-size:14px;"></span>
</div>
</div>
</div>
</div>
</div>
<div class="thankBtn">
<div class="thank-btns">
<input type="hidden" name="method" value="share_details">
<a href="javascript:void(0);" title="Submit" type="submit" id="share_form_submit" class="blue_btn radius3 trans">Submit</a>
<a href="javascript:void(0);" title="Cancel" id="close_share_popup" class="orange_btn radius3 trans">Cancel</a>
</div>
</div>
</div>
</form>Text Content
Login Sign Up
* Home
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Login Sign Up
Welcome to your e-PsychiatryPro dashboard. Once we complete our review of your
credentials and approve your access to patient PHI, you will be given access to
our Initial Consult Queue to begin treating new patients who are seeking care on
our site. We will notify you by email when this process is complete.
Meanwhile, e-Psychiatry has already granted you access to many of the tools and
functions on this dashboard. This allows you to review the site and personalize
your website settings now. For example, in the left-hand toolbar, you can create
your Provider Profile (which we use to alert you to new patients who match your
credentials). You can also establish a confidential job profile for interested
employers to review on a deidentified basis (you only share your identity with
employers if you have interest). In addition, you can run a quick check of your
computer speed, audio, and video for videoconference purposes, etc.
Our technology is constantly being enhanced to improve your user experience, and
we always welcome your feedback. Thank you for allowing e-Psychiatry to support
your telepsych practice.
Close
For HIPAA security purposes, please click “Yes” below to confirm you are still
actively using the e-Psychiatry platform. If you are no longer using the
platform, please save your work and log out. Otherwise, the system will timeout
in minutes.
Yes
CONTACT US
Department Choose a department Sales Provider Relations Customer Service IT
Name
Email
Phone Number
Comment
INQUIRIES
* Careers
* Press
BE SOCIAL WITH US
*
*
*
YOUR MESSAGE HAS BEEN SENT. A MEMBER OF E-PSYCHIATRY'S TEAM WILL CONTACT YOU TO
RESPOND TO YOUR INQUIRY. THANK YOU.
For a Better experience please use our mobile app. Click the Download button to
add the
e-Psychiatry mobile app to your smartphone.
e-Psychiatry Meds & Therapy
Download
IT’S TIME FOR YOUR SESSION WITH DOCTOR – CLICK HERE TO BEGIN
Join Session
THANK YOU FOR RECOMMENDING E-PSYCHIATRY TO YOUR FRIEND OR COLLEAGUE. PLEASE
PROVIDE THE BRIEF INFORMATION REQUESTED BELOW, AND “SEND” TO INVITE OTHERS TO
E-PSYCHIATRY.COM.
Share my name with the people who received my recommendation.
Don't share my name with the people who receive my recommendation (anonymous
recommendation).
Let others know I invited them to e-Psychiatry
Don't let others know I invited them to e-Psychiatry
Title First Name Last Name Email Select Title Dr. Mr. Ms. Add More
Send Cancel
First Name
Last Name
Email
Submit Cancel
Close
YOUR KEYBOARD'S CAPS LOCK IS ON, IF YOU WANT TO CONTINUE AS CAPS LOCK ON CLICK
"OK" AND CONTINUE.
Ok
INITIAL CONSULT
Initial Consult Fee:
The patient pays this full fee by payment card at the end of your session.
The patient receives a payment receipt from e-Psychiatry they can use if they
plan to seek reimbursement from an insurer. The patient has been advised that
e-Psychiatry cannot guarantee insurer reimbursement, and that the patient should
confirm this in advance of your session.
If you are a participating ("par") provider with this patient’s insurer, you may
use the Initial Consult Fee shown above, or you may apply your own separate fee
schedule with this insurer. If you intend to apply your separately contracted
fee schedule with this insurer, please notify your patient in advance, and be
sure to follow your contractual obligations with this insurer related to patient
copays, coinsurance, and insurer claims submission. In rare instances, if the
services you provide during your initial consult are inconsistent with a
standard initial consult CPT code and fee, you may apply an alternative CPT code
and associated fee if appropriate.
e-Psychiatry Admin Fee:
Stripe Financial Fee: Your Stripe account fee for processing the patient’s
payment is approximately 3% of the fee that the patient pays to you on the date
of service (there is no Stripe fee for the claim amount you submit to the
insurer).
Fee Schedule for Follow Up Sessions: If you decide to continue treating this
patient beyond your initial appointment, your fee schedule for this patient will
be displayed to you at that time.
Reminder: Be sure to indicate your private practice fees in your Provider
Profile.
INITIAL CONSULT
Initial Consult Fee:
Providers charge the patient a copay or coinsurance, and submit a claim to the
payer for the rest of the fee. Please confirm the patient's copay or coinsurance
and deductible in advance of your session by contacting the payer's Benefits
Department (see below).
The patient has been advised in advance that e-Psychiatry cannot guarantee
insurer reimbursement, and that the patient should confirm this in advance of
your session.
If you are a participating (“par”) provider with this patient’s insurer, you may
use the Initial Consult Fee shown above, or you may apply your own separate fee
schedule with this insurer. If you intend to apply your separately contracted
fee schedule with this insurer, please notify your patient in advance, and be
sure to follow your contractual obligations with this insurer related to patient
copays, coinsurance, and insurer claims submission. In rare instances, if the
services you provide during your initial consult are inconsistent with a
standard initial consult CPT code and fee, you may apply an alternative CPT code
and associated fee if appropriate.
e-Psychiatry Admin Fee:
Stripe Financial Fee: Your Stripe account fee for processing the patient’s
payment is approximately 3% of the fee that the patient pays to you on the date
of service (there is no Stripe fee for the claim amount you submit to the
insurer).
Fee Schedule for Follow Up Sessions: If you decide to continue treating this
patient beyond your initial appointment, your fee schedule for this patient will
be displayed to you at that time.
Reminder: Be sure to indicate your private practice fees in your Provider
Profile.
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