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New Suboxone Program

What To Expect At Your First Appointment

At your first appointment, you will meet with a provider for a thorough evaluation to understand your concerns and symptoms. West Texas Psychiatry utilizes various tests to clarify assessment and reach appropriate diagnosis.​

This form goes through a lot of information some of which you might not feel comfortable discussing in front of your family member, hence the importance of fully completing it prior to meeting with Dr. Pepermintwala or other providers.

Health Insurance Plans

West Texas Psychiatry accepts following major health insurance plans:

Blue Cross Blue Shield PPO

CIGNA PPO

United Healthcare

Coming Soon!!  More Insurance Plans

Fee for Service Clients (Self-Pay)

If your health plan is not accepted or out-of-network, you can still receive services on self-pay basis.

Self-Pay Cost Breakdown

Initial Evaluation: $500 

Includes the following:

  • (Office visit + Rx + in-office rapid UA) =  $400  
  • Urine Drug Screen (sent to lab for confirmation) = $100

**if you contest the in-office rapid UA results and request a 2nd test an additional $40 will be charged to your visit**

** if we feel you have tampered with the sample or attempting to tamper with the process and 2nd test will be initiated and an additional $40 will be charged to your visit**

**Tampering with the sample or attempting to tamper with the process is grounds for possible immediate discharge from the clinic program.**

Weekly Follow-ups $300 x 1 month 
includes the following:

Weekly office visit:  $200 (includes: office visit + Rx + in-office rapid UA).

Weekly Urine Drug Screen (sent to lab for confirmation) $100

  • All new suboxone patients must be seen weekly x 1 month.

If patient remains "clean" x 1 month then patient will be seen monthly but must come in for "drive-by" urinalysis every 2 weeks for Urine Drug Screen (sent to lab for confirmation) $100

  • Failure to do "drive-by" urinalysis every 2 weeks is counted as a "dirty" UA resulting in patient restarting weekly clinic visits x 1 month.​

Instructions

Please download, print and fill out the forms prior to your first appointment with us. To view the forms linked on this page, you will need Adobe Reader. You may download Adobe Reader for free here. Please bring your completed forms with you to our office at the time of your visit.

Suboxone Treatment Forms

Patient
Registration
Form
Suboxone
Treatment Intake Form
Authorization for Release of Health Information
Brief Pain
Inventory
(Short Form)
Suboxone
Medication
List
Suboxone
Opioid
Agreement