NEW PATIENT APPOINTMENT REQUEST

If you are or believe you are experiencing a medical or psychiatric emergency, including suicidal or homicidal thinking, side effects of medication, or any other urgent or time-sensitive matter in which you need an immediate response, do not use this service. Instead, call 911 or go to your closest emergency room.

Appointment Request

Clinical Information:

Please tell us about the person for whom treatment is being requested

If you selected "Another Adult" please do not continue with this questionnaire. Please have that person submit a request on their own. If you selected "Self" you can skip the next question regarding minors.

Please be aware that Melaine Ndi sees patients age 16 and older
What city and state will the patient physically be located in during the time of the appointment (this is important for telemedicine visits - we are seeing some patients in our office however)? If the visit is a telemedicine appointment, please be aware that the patient must be located in the state of Texas.
Please describe the reason(s) you would like to make an appointment (i.e. depression, anxiety, interested in therapy for a recent loss)
Check all of the following that are applicable to the patient: *
What kind of care is being sought? *
Are you requesting this appointment to have any paperwork filled out? *
(i.e. disability evaluation, FMLA forms, occupational evaluation, etc)

Scheduling Info

Do you currently have Medicare or plan to file for Medicare within the next year? *

Appointment Request Policies

Please read the following appointment request policies in detail.

Must be in Texas: I understand that I (or my minor) must physically be in Texas during appointments (if appointments are done via telemedicine) per medical license regulations.

Appointment request: I understand this constitutes a request for an appointment and does not establish a doctor-patient relationship.

Time and Expertise: While I understand that my preferences are strongly considered during treatment planning, I understand that Pathway Psychiatry bills based on time and expertise, not to obtain a specific diagnosis or treatment.

Payment Info

You First Telehealth does not participate in any insurance plans. I understand I am responsible for payment in full at the time service is rendered. If requested, I will be provided a statement to submit to my insurance company, in order to receive reimbursement if I have out-of-network coverage.

An overview of our fees can be found here.

  • Initial consultation 60 minutes – $350
  • Medication management follow-up appointments 20 minutes – $150
  • Follow-up psychotherapy or combination (psychotherapy and med management) appointments 45 minutes – $225
  • Care outside of sessions (telephone calls, paperwork requests, etc.) is billed at my pro-rated hourly rate.