Click below to download the new patient form. You can submit this form through fax, email, or in person. You will then be contacted within two weeks to schedule an appointment.
If a child is becoming a new patient, please click below and fill out the NICHQ Form and submit this form along with the new patient form. This allows us to get to know the child better.
Click below to download the Health Questionnaire which allows us to get to know you better. Please complete and submit this form along with the new patient form.
Office Policy Information
Holistic Approach Mental Health
Dr.Ilya Rozenberg, PhD., C.R.N.P.
Dr.Kristin Bussell, PhD., C.R.N.P.
Maryann Colborn, M.S., LCPC
Welcome to Holistic Approach Mental Health. We are committed to providing you with the best medical knowledge available. In order to accomplish this goal, there are mutual responsibilities and limitations which need to be understood. To ensure we can work together as effectively as possible, please review our office policies below.
Monday: 10 a.m. – 6 p.m.
Tuesday: 10 a.m. – 6 p.m.
Wednesday: 7 a.m. -6 p.m.
Thursday: 7 a.m.-5 p.m.
Saturday: By Appointment Only
As a patient in this practice, you are expected to:
Pay your co-pay at every visit. It is your responsibility to pay any outstanding balances not covered by insurance.
Present your current insurance for verification at every visit.
Present your driver’s license on other picture identification if you are paying with a check or are a new patient.
Make sure we have the correct information for you on file. At every visit, you will review the patient information sheet, contacting the current address, telephone number, and insurance information we have in our records. You must sign this form (or give us corrections and sign a revised form) indicating all the information we have on file is correct. This form also includes a statement acknowledging that you are the person ultimately responsible for paying your bill.
Inform us of changes to your insurance information. You must call us with insurance changes before coming to your next appointment (if required by your insurance) must be obtained before your visit. If time permits, we will try to get the verification on the day of your appointment; however, if we are unable to, you will be required to pay for your visit in full ($85 for a follow- up, $185 for an initial visit) or you can reschedule your appointment to allow us time to complete the verification. Insurance verification cannot be completed before 9am or after 5pm.
Notify us if you cannot keep your appointment. If you are unable to keep your scheduled appointment you must notify the office as soon as possible, at least 24 hours in advance. If we are not notified the day before the next appointment, you will be subject to a charge of $25, which must be paid before your next visit will be scheduled. Repeat cancellations or “no shows” jeopardizes our ability to treat you effectively and may result in dismissal from the practice.
Request prescription refills before 5pm Monday through Thursday. Refill requests received after 5pm on weekdays will be processed on the next business day. No refills are processed on holidays or weekends. It is your responsibility to make sure to make sure that you do not run out of medication before your next appointment. Patients must keep their appointments in order to continue receiving refills on medication. If you have not had a recent appointment, you will be given a refill of only enough medication to last you until the next available appointment (this does not mean the next appointment that is convenient for you).
Payment can be made by cash, or credit card. We no longer accept checks.