CLARITY COGNITIVE CONSULTANTS, LLC
700 Narragansett Park Drive, STE 100
Pawtucket, RI 02861
Practice Policies and Procedures
Effective Date: September 30, 2026
Applies To: All clinical, administrative, and technology-supported activities of Clarity Cognitive Consultants, LLC
1. Purpose
Clarity Cognitive Consultants, LLC provides cash-pay telehealth consultation services for adults seeking structured assessment of possible Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), and cognitive concerns, including cognitive baseline and Mild Cognitive Impairment (MCI) screening. This policy establishes consistent procedures for patient eligibility, service delivery, privacy, documentation, safety, care coordination, financial responsibility, and scope boundaries.
2. Practice Scope and Service Model
The practice operates as a consultation-based, non-longitudinal telehealth service. Services may include:
Comprehensive clinical interviews and review of developmental, medical, psychiatric, cognitive, and functional history.
Structured screening and assessment for adult ASD and/or ADHD.
Cognitive baseline assessment, objective cognitive screening, collateral information review, and longitudinal cognitive monitoring.
Feedback sessions, written consultation reports, and individualized next-step care maps.
Communication of consultation findings to a patient’s primary care provider or other authorized clinician when a valid release of information is on file.
The practice does not provide:
Emergency psychiatric or medical stabilization.
Ongoing psychotherapy.
Ongoing medication management.
Controlled-substance prescribing.
Forensic, legal, disability, fitness-for-duty, custody, immigration, or court-ordered evaluations.
Acute delirium evaluation or management.
Replacement for a comprehensive neurologic, neuropsychological, medical, or in-person examination when such evaluation is clinically indicated.
3. Cash-Pay Status and Financial Responsibility
Clarity Cognitive Consultants, LLC is a cash-pay practice only. The practice does not accept, bill, submit claims to, participate with, or seek reimbursement from commercial insurance plans, Medicare, Medicaid, or other third-party payers.
All patients are financially responsible for the full cost of services. Payment terms, cancellation terms, refund eligibility, and service fees are provided before scheduling or service delivery. Patients may request a Good Faith Estimate of anticipated charges before services are rendered.
The practice does not provide superbills, insurance claims, prior authorizations, or documentation intended to obtain insurance reimbursement unless expressly stated in writing.
4. Geographic Eligibility and Telehealth Location Verification
Services are available only to adult patients physically located in Connecticut, Massachusetts, Rhode Island, New Hampshire and Vermont at the time of each telehealth encounter.
Before each synchronous telehealth encounter, the clinician will document:
Patient identity verification.
Patient’s current physical location and address.
A call-back telephone number.
Emergency contact information when clinically appropriate.
Whether another person is present during the visit and the patient’s consent for that person’s participation.
If a patient is outside an authorized jurisdiction at the time of service, the appointment will be rescheduled or canceled. The practice will not provide clinical consultation across jurisdictions where the clinician is not authorized to practice.
5. Patient Eligibility and Clinical Appropriateness
All prospective patients undergo preliminary screening to determine whether the requested consultation is appropriate for the practice’s scope and telehealth model.
Patients may be deferred, referred, or directed to a higher level of care when there is evidence of:
Active suicidal or homicidal intent, plan, or inability to maintain immediate safety.
Acute psychosis, mania, intoxication, withdrawal, delirium, or severe behavioral dysregulation.
A medical emergency or rapidly progressive cognitive change requiring urgent in-person assessment.
A need for ongoing psychiatric treatment, medication management, psychotherapy, or intensive case management.
Functional, sensory, language, technology, environmental, or clinical factors that substantially limit the validity or safety of remote assessment.
A referral question requiring formal neuropsychological testing, forensic evaluation, disability determination, or other service outside the practice’s scope.
Clinical appropriateness is determined by the clinician on a case-by-case basis. Completion of screening forms or scheduling an appointment does not guarantee that a consultation will proceed.
6. Intake, Consent, and Pre-Visit Requirements
Prior to the clinical consultation, eligible patients must complete required intake materials, which may include:
Demographic and contact information.
Medical, psychiatric, developmental, educational, occupational, and functional history.
Telehealth informed consent.
Financial policy acknowledgment and Good Faith Estimate, when applicable.
Privacy practices acknowledgment.
Authorization for release or exchange of information, if applicable.
Collateral informant forms, when clinically relevant.
Digital assessment instruments and performance-based cognitive tasks, when clinically indicated.
Patients are responsible for providing complete and accurate information. Incomplete intake requirements may delay scheduling, assessment, or report completion.
7. Telehealth Standards
Telehealth services are conducted through secure, HIPAA-aligned technology platforms. Patients are expected to participate from a private, quiet, well-lit location with reliable internet access and a device capable of secure audio-video communication.
The practice may reschedule, modify, or discontinue a telehealth assessment when:
Audio, video, connectivity, privacy, or environmental conditions compromise clinical quality or test validity.
A patient cannot safely or meaningfully participate through telehealth.
The clinician determines that an in-person or higher-level assessment is necessary.
Patients should not participate while driving, operating machinery, in a public setting, or otherwise unable to safely engage in the appointment.
8. Assessment and Testing Standards
Assessment conclusions are based on clinical interview, available records, patient report, collateral information when available, structured rating measures, behavioral observations, and testing results as clinically appropriate.
Digital and remote cognitive tools are used as one component of a broader clinical evaluation. Results may be affected by factors including technology quality, environmental distractions, language, education, sensory impairment, physical health, fatigue, mood symptoms, sleep, medication effects, effort, and familiarity with digital devices.
The clinician will document material limitations affecting interpretation. A screening result or digital cognitive assessment alone does not establish a diagnosis and may warrant additional medical, neurologic, neuropsychological, psychiatric, or in-person evaluation.
9. Consultation Reports and Turnaround Times
The practice offers service tiers based on scheduling and report-delivery priority.
Premium Speed Tier: Written report delivered within 7–10 days after completion of all required clinical components.
Standard Access Tier: Written report delivered within 21–28 days after completion of all required clinical components.
Turnaround time begins only after the patient has completed the clinical interview, required testing, required forms, and any clinically necessary collateral or records review. Delays may occur when required materials are incomplete, records are unavailable, additional clinical clarification is required, or circumstances outside the practice’s reasonable control interfere with timely completion.
Reports are consultation documents intended to support the patient and authorized treating clinicians. They are not guarantees of workplace, academic, insurance, legal, or disability accommodations.
10. Feedback and Care Coordination
Patients receive a feedback session to review consultation impressions, results, limitations, and recommended next steps. With patient authorization, the final report may be shared with the patient’s primary care provider, referring clinician, or other designated recipient.
The practice does not assume responsibility for implementing recommendations, arranging referrals, managing medications, monitoring acute symptoms, or providing ongoing treatment after the consultation episode concludes.
11. Brain Track Annual Monitoring Subscription
The Brain Track Annual Monitoring Subscription is an optional longitudinal cognitive-monitoring service for eligible patients who have completed a cognitive baseline consultation.
The subscription may include:
Periodic adaptive digital cognitive re-screening.
Comparison of follow-up results with the patient’s prior baseline data.
A longitudinal trajectory summary or graph, when technically and clinically available.
Transmission of updated results to the patient’s primary care provider or other authorized clinician when a valid release of information is in place.
Brain Track is a monitoring and data-tracking service, not emergency monitoring, real-time surveillance, diagnosis of acute cognitive change, or treatment management. Patients remain responsible for seeking timely evaluation from their primary care clinician, neurologist, emergency department, or other appropriate service for new, rapidly worsening, or urgent symptoms.
Subscription enrollment, renewal, cancellation, payment terms, and communication preferences will be governed by the patient’s signed enrollment and financial agreement.
12. Emergencies and Crisis Procedures
The practice is not an emergency service and does not provide 24-hour coverage, crisis response, or urgent same-day intervention.
Patients experiencing a medical or psychiatric emergency, active safety concern, or immediate risk of harm should call 911, go to the nearest emergency department, or contact 988 for the Suicide & Crisis Lifeline.
If an acute safety concern emerges during a telehealth encounter, the clinician may take reasonable steps to support immediate safety, including contacting emergency services, a listed emergency contact, or another appropriate local resource. The patient’s physical location at the time of the encounter is therefore required.
13. Privacy, Security, and Records
The practice maintains clinical records in secure electronic systems and uses HIPAA-aligned platforms for patient communication, telehealth, scheduling, document storage, and assessment workflows.
Protected health information will be used and disclosed only as permitted by law, professional standards, and applicable patient authorizations. Patients should use the secure patient portal or other approved method for clinical communications and should not send urgent or sensitive information through unsecure channels.
Clinical records are retained and released in accordance with applicable law, professional standards, and the practice’s records-management procedures.
14. Communications and Response Expectations
Routine administrative communications are handled during regular business operations. Portal messages, email, voicemail, and electronic forms are not monitored continuously and are not appropriate for urgent or emergency concerns.
The practice may communicate with patients regarding scheduling, forms, payments, testing links, reports, and follow-up administrative needs. Patients are responsible for maintaining current contact information and checking communications from the practice.
15. Nondiscrimination and Accessibility
The practice is committed to respectful, neurodiversity-affirming, trauma-informed, and nondiscriminatory care. Services are provided without discrimination based on race, color, ethnicity, national origin, religion, sex, sexual orientation, gender identity, age, disability, socioeconomic status, or other protected status.
The practice will make reasonable efforts to identify and address access barriers related to disability, language, digital literacy, hearing, vision, or technology. Some requested accommodations may require referral to an in-person or otherwise more appropriate service when remote assessment validity or safety cannot be reasonably maintained.
16. Professional Boundaries and Referrals
The practice maintains clear professional boundaries consistent with its consultation model. Patients requiring services outside the practice’s scope will be provided appropriate referral recommendations when feasible.
Referral recommendations do not establish responsibility for another provider’s availability, acceptance of insurance, scheduling, treatment decisions, or clinical outcomes.
17. Quality Assurance and Policy Review
The practice will periodically review clinical workflows, turnaround performance, patient safety processes, privacy safeguards, technology functionality, patient feedback, and referral patterns.
This policy may be revised to reflect changes in applicable law, professional standards, technology, operational needs, or clinical scope. The current version will govern practice operations unless superseded in writing.
Approved By: Dante Aliesh Peterson, FNP-C, PMHNP-BC, CCHP
Founder and Clinical Lead
Clarity Cognitive Consultants, LLC
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CLARITY COGNITIVE CONSULTANTS, LLC
Cash-Pay Financial and Cancellation Policy
Effective Date: September 30, 2026
Cash-Pay Practice
Clarity Cognitive Consultants, LLC is a cash-pay practice only. We do not accept, bill, submit claims to, participate with, or seek reimbursement from commercial insurance plans, Medicare, Medicaid, or other third-party payers.
All services are self-pay. Patients are solely responsible for all charges associated with scheduled services, assessments, consultations, reports, subscriptions, and other requested services.
Service Fees
Current service fees are published by the practice and are provided before scheduling. Fees may be revised prospectively. The fee in effect at the time a patient schedules and accepts a service will apply to that scheduled service unless otherwise agreed in writing.
The following services are currently offered:
ServiceFeeComprehensive Adult Autism/ADHD Consultation — Premium Speed Tier$1,550Comprehensive Adult Autism/ADHD Consultation — Standard Access Tier$950Cognitive Baseline & MCI Screening Consultation — Premium Speed Tier$1,150Cognitive Baseline & MCI Screening Consultation — Standard Access Tier$750Brain Track Annual Monitoring Subscription, if elected$295 per year
Payment Terms
Payment is due according to the payment schedule disclosed during booking and before services are provided. The practice may require payment in full, a deposit, or a completed payment authorization before confirming an appointment, releasing testing materials, beginning record review, or issuing a final report.
A patient’s appointment, assessment process, report delivery, or subscription enrollment may be delayed or canceled if required payment is not received.
Good Faith Estimates
Patients have the right to receive a Good Faith Estimate of expected charges before services are provided. The estimate will reflect services reasonably expected at the time it is issued.
A Good Faith Estimate does not include:
Services not reasonably anticipated at the time of the estimate.
Additional services requested by the patient after the estimate is issued.
Charges for services provided by another clinician, facility, laboratory, imaging center, pharmacy, or referral provider.
Costs associated with emergency care, hospitalization, or services outside the practice’s scope.
If a patient receives a bill that is at least $400 more than the Good Faith Estimate, the patient may have the right to dispute the bill through the federal patient-provider dispute resolution process.
Cancellations and Rescheduling
Patients who need to cancel or reschedule an appointment must provide at least 48 business hours’ notice.
Appointments canceled or rescheduled with at least 48 business hours’ notice may be rescheduled, subject to availability.
Appointments canceled or rescheduled with fewer than 48 business hours’ notice may be subject to a cancellation fee of $150.
Failure to attend a scheduled appointment without notice may be treated as a no-show and may be subject to a fee of $150.
Repeated late cancellations or no-shows may result in discharge from the scheduling process or a requirement for full prepayment before future scheduling.
Cancellation and no-show fees compensate for reserved clinical time and are not applied toward future services unless the practice agrees otherwise in writing.
Late Arrival
Patients are expected to join telehealth appointments on time. Late arrival may reduce the available appointment time and may compromise the validity or completion of an assessment.
Patients arriving more than 15 minutes late may need to reschedule. The appointment may be considered a late cancellation or no-show when the assessment cannot be completed within the reserved time.
Assessment Preparation and Completion
Patients are responsible for completing required intake forms, consents, questionnaires, testing, and requested collateral materials by stated deadlines. Delays in completing required materials may delay the clinical interview, feedback session, report completion, or selected report-turnaround timeline.
The practice may determine that an assessment cannot be completed or interpreted reliably when required materials are incomplete, the telehealth environment is not clinically appropriate, testing conditions are invalid, or an in-person or higher-level evaluation is needed.
Refunds
Fees paid for completed clinical services, completed testing, clinical record review, feedback sessions, or completed reports are generally nonrefundable.
If the practice determines before the clinical interview that the requested consultation is not clinically appropriate or cannot be provided within the practice’s scope, any refund will be determined based on services already completed and nonrecoverable administrative or testing costs.
If a patient chooses to discontinue an assessment after clinical work, testing, or record review has begun, the patient remains responsible for charges related to work already completed.
Report Delivery
Written reports are released after all required clinical components are complete and all outstanding balances are paid.
Premium Speed Tier reports are generally delivered within 7–10 days after all required clinical components are complete. Standard Access Tier reports are generally delivered within 21–28 days after all required clinical components are complete. These timeframes may be extended when additional records, collateral information, clinical clarification, or other necessary assessment components are pending.
Brain Track Annual Monitoring Subscription
The Brain Track Annual Monitoring Subscription is an optional service for eligible patients who have completed a cognitive baseline consultation. The subscription fee is billed annually according to the enrollment agreement.
Patients may cancel future renewal of the subscription before the next annual billing date. Fees already paid for an active subscription period are generally nonrefundable. Brain Track is not an emergency monitoring service and does not replace medical, neurologic, or psychiatric care.
Insurance and Reimbursement
The practice does not provide insurance billing, prior authorization services, insurance claims, or reimbursement support. Patients should not expect the practice to provide documentation for insurance reimbursement unless expressly agreed in writing.
Questions About Fees
Patients are encouraged to ask questions about fees, payment timing, Good Faith Estimates, cancellations, or financial responsibility before scheduling or beginning services.
By scheduling services, submitting payment, or receiving services from Clarity Cognitive Consultants, LLC, the patient acknowledges receipt of and agrees to this Cash-Pay Financial and Cancellation Policy.
Approved By:
Dante Aliesh Peterson, FNP-C, PMHNP-BC, Founder and Clinical Lead
Clarity Cognitive Consultants, LLC