Medical Policies and Forms

Medical Policies and Forms

Dr. Jeffrey DeSarbo's Office Policies

New Patients

Dr. Jeffrey DeSarbo, D.O. | Policies | Forms | Garden City NY | Long Island NYPlease arrive 15 minutes before scheduled appointment time to complete any paperwork that may be required. Please go to the Intake Forms section on this page and print out the appropriate form to fill out and bring to your first appointment. Also be sure to print out and bring this formed signed by you as well. As soon as you arrive at the offices, please check-in with the office manager in the reception area.


Appointments and Cancellations

Unlike other medical professions, the practice of psychiatry in more time consuming and does not allow the office to “double book” appointment times allowing for missed appointments by patients. Dr. DeSarbo’s office requires a 24hr.notice for cancellations or patients will be billed for missed appointments. In some instances, a telephone session may be substituted at the scheduled time. Please note that when appointments are missed or rescheduled with short notice it may be difficult to reschedule since the office calendar is often booked weeks in advance. Fees for missed appointments and cancellations within 24 hours are as follows: $50 for 1st missed/cancelled appointment; $100 for 2nd missed/cancelled appointment; full session cost after 2nd missed/cancelled appointment. The office will often make reminder calls the day before your appointment. Please note that it is ultimately your responsibility to remember the date and time of your appointment and not rely on the reminder call which may be missed. Also, note that these calls are to remind patients of their scheduled appointment, NOT to confirm the appointment. Any cancellations made with these calls and within 24 hours are subject to charge as mentioned above.


Payment for Services

Payment for services are due at the time of service. This office does not bill for appointments. Advance payments for a block of sessions is accepted. Payment may be made by check or cash (no credit cards). A $20 fee for all returned checks will be charged.


Telephone Calls

Dr. DeSarbo may be reached most days of the week through his office telephone number. For urgent matters, patients may also call Dr. DeSarbo’s cell phone number. For emergencies, patients should always call 911. Due to Dr. DeSarbo’s daily schedule, most telephone calls will usually be returned after office hours in the evening. Dr. DeSarbo will always try to return calls within 24 hours, however, if you do not here back within 24 hours please call again. Due to the significant number of calls received each day, please reserve therapy issues and other non-urgent matters for discussion at your next scheduled visit. Changes to medications require an office visit or scheduled telephone consult. If family members have expressed and/or legal permission to participate in a patient’s care, they are expected to be at the scheduled office appointment with the patient. Follow-up telephone calls for caregivers not present at the office visit are subject to a session charge or a minimum of $25, however, with permission from the patient, a caregiver may be on put on a conference call during the in-office session.


Requested Reports and Forms

Any reports, forms or other paperwork that must be generated or completed and is requested by the patient or a third party on the patient’s behalf are subject to a charge of $350/hr (minimum charge $50). The patient is responsible for the fees due for any requested materials (third parties will not be billed).


Medical Prescriptions

Follow-up appointments are usually scheduled to ensure that you do not run out of medications prematurely between appointment times. However, if you miss a scheduled appointment time or in other circumstances that require a telephone/electronic prescription to be placed or mailed to your pharmacy, a $15 fee will be billed and applied to your next visit. Controlled substances require a monthly appointment.


Insurance Billing

Fees for appointments are due on the day services are rendered. Dr. DeSarbo is not a provider for private insurance companies and does not accept insurance. However, Dr. DeSarbo’s office will complete and provide the necessary invoices with codes for you to submit to your insurance provider for direct reimbursement to you on a monthly basis if requested. Please note that many patients prefer the privacy of psychiatric care and when insurance reimbursement is sought, the insurance company has the right to a patient’s medical/psychiatric care and records.



Please print, fill-out and bring with you any forms needed for your appointment.


General Intake Form

Required for all new patients coming in for first visit.


Eating Disorder Intake Form

Required for all new patients seeking eating disorder treatment.


Bariatric Intake Form

Required for all patients seeking bariatric surgery clearance.


Permission to Treat a Minor

Required to be filled out by parents or legal guardians of any new patient under the age of 18.