Dear Prospective Patient:

Thank you for your interest in Silva Psychiatric Care (SPC). Like the advent and rise of Telemedicine, the Concierge Practice Model is one of the newer innovations in the medical field. The model is also sometimes called "retainer medicine," because concierge practices uniformly require patients to pay an annual fee, simply for the privilege of belonging to the practice. The amount of this fee varies widely, but even the smallest fees are several hundred dollars, usually collected quarterly: the annual cost typically exceeds one thousand dollars, and you must bear in mind that this expense is in addition to the actual cost of treatment!

I am happy to offer concierge-level service to my patients, including direct access to, and responsiveness from, me, personally, at all times, but this practice does not impose an annual membership fee, nor any surcharges of any kind; professional fees are only ever levied for actual services rendered, collected at the time of the appointment, or other service.

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CLICK HERE FOR WHAT PATIENTS HAVE TO SAY ABOUT THE CONCIERGE MODEL

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CONCIERGE-LEVEL VIP PATIENT SERVICE INCLUDES:

1. Direct, and immediate, access to your physician, at all times. The practice phone number directs to my personal cell phone, and if I am available, I will answer. Texts are also encouraged as a convenient, and rapid, way of getting in touch with me and requesting callbacks. If I am unable to answer, voicemails are retrieved and reviewed as soon as possible, and messages returned and/or requests processed as quickly as possible, as well--again, by me, personally.

Because I employ no staff, you will never speak to anyone about your care with me, but me: no receptionists to relay messages, no nurse practitioners or physician assistants to substitute, no one but you and I, and any family members or caretakers closely involved in your care, whom you invite to join our sessions. Please see my Treatment Philosophy to learn more about what you can expect from our meetings.

Besides a cell number which you are also welcome to text, e-mails sent through the patient portal will be processed within 3-5 business days. Again, all requests are always handled by me, personally, and are processed as quickly as possible after I receive them.

The fees paid at each visit also cover any need to communicate with me between appointments as necessary, whether by phone or through the SPC Patient Portal, including briefly touching base about dosing changes; you will not be expected to return to see me and pay another visit to oversee minor, expected changes to your medications' dosage(s). Similarly, time spent coordinating care with other providers, including therapists, home health nurses and/or primary care physicians, is part of the high standard of care offered at SPC, and covered by the fees paid at each visit, which have not changed in SEVEN years.

For more INFORMATION about enhaNced access to your physician, including the availability of extended, counseling visits and pro Bono follow-up calls, see here.

2. Same-day, or next-day, access: patients are able to schedule, cancel and reschedule their own appointments via the patient portal, but limited concierge practices are able to offer appointments WITH VERY SHORT NOTICE, TYPICALLY within a day or two, and sometimes even the same day. EXCEPT IN THE CASE OF true medical emergencIES, IF you have an urgent need to meet with me, I AM ABLE TO offer very short waiting periods for an impromptu follow-up appointment, EVEN IF YOU MISSED YOUR LAST APPOINTMENT AND ARE OVERDUE.

this IS ESPECIALLY true for new patients, interested in joining the practice: immediate appointments are available, INCLUDING WEEKENDS and EVENINGS, in a field that, in some locations, individuals have TO WAIT several weeks, OR EVEN MONTHS, before they are offered a visit, ONLY TO HAVE TO THEN MISS WORK OR SCHOOL, COMMUTE SOMETIMES LONG DISTANCES, AND THEN spend HOURS, mostly sitting in a waiting room.

3. Little or no waiting time also applies at each visit. I pride myself on punctuality, and I am rarely more than 5 or 10 minutes behind schedule. Any patient familiar with typical wait times at a busy medical practice will appreciate the difference. When I do run a few minutes behind, it is because I am spending the time necessary to fully and thoroughly address the concerns of the patient that came before; standard follow-up appointments are scheduled for up to fifteen minutes, but appointment times are approximate.

Moreover, the concierge experience includes an unhurried atmosphere; rest assured that I will always spend the necessary time to properly and completely evaluate and reevaluate your condition, and to review and explain all of your treatment options. To this end, extended, thirty-minute appointments are always available for those patients who require or prefer more face-to-face time with me. longer counseling sessions are also offered, at a discounted rate.

​The advantage of telemedicine--of virtual house calls and essentially eliminating the waiting room--is that, even when I must run behind, you are free to enjoy the comfort and privacy of your own home and to attend to other tasks until I come online, not only drastically improving the waiting experience and ensuring the highest degree of privacy and confidentiality, but also, in combination with eliminating travel, freeing up hours of valuable time.

Along with these provisions, a concierge telemedicine practice allows me to be extraordinarily flexible with my schedule. In most instances, if technical difficulties or other unforeseen obstacles cause you to run behind for an appointment, I do always try my best to find another open slot the same day to allow you to be attended, and to avoid being charged for missing an appointment, including early evenings. Early-evening appointments are, in fact, routinely offered, to accommodate school and work schedules. For new patient evaluations, which require a full hour, weekend appointments are also typically available.

4. Prescriptions: all medications, including SCHEDULE II controlled substances, are filed electronically with the pharmacy of your choice, streamlining the process of having medications filled and refilled by eliminating the initial trip to drop off paper scripts, only to have to either wait, or return at a later time, or even another day, to pick up the actual medication. Using advanced software, I am able to receive and respond to refill-request texts (please text whenever possible) using my own mobile device, even when I AM out of the office. I can also review your medical record, and respond to your needs accordingly at all times, no matter where I happen to be.

Although the majority of patients respond rapidly and well to treatment, and most individuals under my care do not require many interventions between visits, nonetheless knowing that I am just a phone call, or an e-mail, or a simple text message away--both to patients as well as their authorized family members--is, I hope, reassuring.

I strive to make the experience of consulting a psychiatrist as comfortable, and convenient, and satisfying as possible, and I am always open to, and interested in, your sincere feedback.

If you have other concerns about joining the practice, please do not hesitate to contact me directly at (432) 692-4525, and I will be happy to answer any additional questions you might have.

Sincerely,
Dr. Silva, M.D.