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Release of Information Completion of this form is very important – it will allow Salem Psychiatric Associates to understand your medical diagnosis, treatments, and medication.
Client Records Request Helps outside providers get medical and health information.

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If you have an immediate emergency contact 911 or the Psychiatric Crisis Center at 503-585-4949

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
--You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
--Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
--If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
--Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call the office at 503-362-1999.

Salem Psychiatric Associates
821 Saginaw Street South
Salem, Oregon 97302

Office Hours: Monday - Friday 8:30 AM - 4:30 PM
Phone Hours: Monday - Friday 8:30 - 4:30 PM

P: 503-362-1999
F: 503-362-9671
salempsych.com

Valley Mental Health
821 Saginaw Street South
Salem, Oregon 97302

Office Hours: Monday – Friday 7:30 AM – 4:30 PM
Phone Hours: Monday – Friday 8:30 AM – 4:30 PM

P: 503-589-4046
F: 503-480-0484
https://valleymental.com/

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Video Appointments

Important Reminders Before your Appointment:

If you enter your provider’s virtual waiting room more than 10 minutes past your appointment time, your provider may no longer be available to see you. 
If you are experiencing technical difficulties, it is important that you call our office within the first 5-10 minutes of your appointment so that our staff can help you connect with your provider. Your provider will not be able to prescribe any medications if they cannot complete a visual assessment at the time of your appointment. 
If you need to cancel or reschedule this appointment, please contact out office at least 48 hours in advance or your appointment may be marked as a late cancellation.
The front office can be reached at (503) 362-1999 and press option 0 when prompted.

Here are some tips for a great call with your provider:

Use a computer, cellphone, or tablet with a working camera and microphone. 
Make sure that you are connected to the internet with an Ethernet cable or strong Wi-Fi connection.
Make sure that you are using an internet browser that is updated and compatible with Doxy.me or Zoom. For PC computers and Android devices, use Google Chrome. For Mac computers and Apple devices, use Safari.

Medication Management Appointments

Sandra Bassett, PMHNP Tymberly Seim, MD

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