WELCOME TO AMEN CLINICS
INFORMATION PACKET
This packet contains important details and policies regarding your upcoming visit to Amen Clinics. Please
review this information before your first appointment.
Please Note: You may or may not be scheduled for all of the appointment types discussed in this packet.
TABLE OF CONTENTS
INFORMATION PACKET 2
FULL EVALUATION 3
Clinical History 3
WebNeuro Online Testing 3
SPECT Scans 4
During Your Appointment 5
Medication and SPECT 5
Quantitative Electroencephalography (qEEG) 6
Final Evaluation 7
Amen Clinics Method Coaching 8
Follow-Up Appointments 8
Cancellation/Reschedule Policies 9
Fees and Other Evaluation Options 10
Insurance Procedure Codes 11
Frequently Asked Questions 12
CLINIC LOCATIONS 13
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FULL EVALUATION
This comprehensive evaluation will allow us to create a personalized and targeted treatment plan for you. It will
involve several highly-trained professionals, including your physician who you will meet with on the last day.
CLINICAL HISTORY
During this appointment, one of our trained Outcome Managers will discuss your symptoms, medical and mental health
history. Everything discussed during your intake appointment may be included in your final report (unless otherwise
specified by you). Your best answers will allow your doctor to develop the best treatment plan for you.
WEBNEURO ONLINE TESTING
| WebNeuro is an objective, web-based emotional and cognitive neuro-diagnostic testing service. It’s an important
part of our evaluation process.
| It will ask questions to examine how you’ve been feeling and functioning over the past week or so. It will also give
you game-like tasks to complete. There is no pass or fail.
| Requirements to take the test:
y The patient must be able to read English.
y The test requires a keyboard with a mouse (or a touch pad).
y It takes around 40 minutes to complete.
y A high-speed Internet connection is recommended but not required.
y For the assessment to run properly, close all other computer applications during the test.
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FULL EVALUATION
| Prepare the room: Make the room as quiet as possible and decrease distractions, so you can better concentrate.
| Parent’s role as a supervisor (for patient’s ages 6-17)
y Let your child know that you are available to help them read and understand the instructions at any time.
Once the instructions are understood, and the assessment has begun by clicking the OK button, you should
allow your child to complete the task questions on their own, even if they struggle with it.
y It is important that your child complete the test without pressure to perform. Do not sit behind your child and
watch them take the test. Allow them to be independent, but be close enough to clarify the instructions for
them, if needed.
| If you’re unable to complete the test, you can use scheduled time in the clinic to complete it.
SPECT SCANS
At Amen Clinics, we use brain single-photon emission computed tomography (SPECT) imaging as a tool to diagnose
and treat patients. SPECT allows us to look inside the brain and see in 3D three important areas of the brain:
1 Areas that work well
2 Areas that work too hard
3 Areas that do not work hard enough
This information is analyzed and used throughout your treatment.
Your scans and clinical history help us understand the underlying brain patterns associated with your issues
and help us pinpoint the right treatments. For detailed information on the benefits of SPECT imaging, visit
www.amenclinics.com
Normal Alzheimer’s TBI OCD
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FULL EVALUATION
DURING YOUR APPOINTMENT
To inject the medicine for the scan, a small IV will be started in a vein in your arm. Afterwards, you will lie down on a
table so the SPECT camera can take the image of your brain’s activity.
If you have an acute sensitivity to pain or a fear of needles, we offer EMLA® Cream (lidocaine, prilocaine) to numb
the administered area. To use this option, please let us know when you schedule and arrive at the clinic 30 minutes
before your scan.
Most people get two scans, one while doing a concentration task, and one at rest. If you are only having one scan, it is
typically done with a concentration task. During the concentration scan, you will take a 15-minute computerized test
that measures attention and focus. During the resting scan, you will be instructed to sit quietly.
The SPECT process takes typically 20 to 25 minutes for each scan and requires you to be COMPLETELY STILL. Once the
scan’s data has been collected and approved, your scan appointment is done for the day. The scan technologist will
guide you through the process and will answer any questions you may have.
MEDICATION AND SPECT
Some people are cautious about being scanned while on medications. In general, we recommend patients to
discontinue stimulants, such as Ritalin and Adderall, 4 days before the first scan and to stay off of them until the
second scan is completed. If you are concerned about going off your stimulants for the full four days, please know
that many patients get scanned on their medications, and their scans are still extremely valuable to their treatment.
IMPORTANT: Never discontinue any necessary medications or supplements, especially if they’re needed for daily
functioning. These include, but are not limited to, psychiatric medications and medications for blood pressure, blood
thinners, diabetes, thyroid, heart and lungs. If you decide to be scanned off all medications and supplements, YOU
MUST do so under the guidance of your healthcare provider. Always check with your doctor before reducing or
discontinuing any medication.
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FULL EVALUATION
QUANTITATIVE ELECTROENCEPHALOGRAPHY (QEEG) - ADD ON OPTION
DELTA THETA ALPHA BETA HIGH BETA
QEEG measures the brain’s electrical patterns at the surface of the scalp. Color maps are used to show which areas
of your brain are under active or overactive and how different areas of the brain are communicating with each other.
The results of the QEEG provide important information in guiding your treatment.
For those who decide to add on a Quantitative electroencephalography (qEEG) which is performed only in Atlanta, New
York, Orange County, CA, and Washington, DC, this will be done with a follow-up appointment to go over the results.
The final evaluation is the last appointment scheduled. The clinical history, two brain scans (and qEEG if done), can
occur in any order. The information gathered in these appointments is given to your Amen Clinics physician, who will
then review it and meet with you in the final evaluation and subsequent follow-up appointments.
PREPARATION FOR QEEG APPOINTMENT INCLUDES:
(These instructions do not apply to all patients—ONLY those scheduled for a qEEG appointment.)
| Sleep: Get plenty of rest the night before.
| Hair and Scalp: Your hair needs to be clean and dry.
y Do not use oils, lotions, mousse, gels or hairsprays.
y No chemical treatments may be administered (coloring, perms, relaxers, etc.) within 48 hours of QEEG.
| Medications: Do not make changes in any other medication(s) unless authorized by your physician.
THE DAY OF YOUR QEEG
| 24 hours before your QEEG, avoid illicit drugs, stimulant medications, caffeine, and cold medications.
| Eat a healthy, high protein breakfast.
| Procedure: A water-based gel will be placed in your hair to facilitate conductivity. It’s odorless and colorless, and
can be washed out with water. We recommend bringing a hat, comb, and/or hairbrush.
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FINAL EVALUATION
After testing, history and scans have been completed, you will meet with a physician for your final evaluation. Though
you will not meet with Dr. Amen, you can be confident in knowing that each of our physicians has been selected,
trained and approved by him. Dr. Amen regularly consults with our doctors and medical professionals.
During the appointment, the physician will review your test results, clinical history, and scans. Additional information may
be requested from you, and any questions you may have will be addressed. Your physician will develop an individualized
treatment plan for you. The written report of your final evaluation will be completed after your appointment.
Your treatment plan may or may not include recommendations for prescription medications. We cannot guarantee
you will receive a written prescription. Your physician will also discuss whether or not it’s possible to continue
treatment at our clinic. If you’re from out-of-state or another country, it’s recommended that you find a physician in
your area who is willing to collaborate with us before your visit. We can then work with your local doctor in prescribing
agreed upon medications. State laws may prohibit us from writing prescriptions for patients who are out-of-state. If
you are unable to establish care with a local doctor, before coming to Amen Clinics, we can make a recommendation
for you from our current referral list, but can’t guarantee we have an affiliate in all areas.
Amen Clinics is often used by people around the world as an ongoing consultation service. Our recommendations
often include treatments other than prescription medications (e.g. natural supplements, dietary changes, nutrition
plans, exercise, and various forms of therapy) that can be implemented at home or with a local practitioner.
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AMEN CLINICS METHOD COACHING
Included in your evaluation are two 20 to 25-minute appointments with your Outcome Manager. These can be
done by phone or in person.
The first appointment is scheduled approximately two days after your evaluation. It is a follow-up appointment to
help you complete the next steps in your treatment and answer any questions you may have.
The second appointment is also a follow-up. This appointment is scheduled after you’ve had some time to get
started on your treatment plan. During this appointment, your Outcome Manager may spend time coaching,
troubleshooting personal challenges and helping you find additional resources.
FOLLOW-UP APPOINTMENTS
The first follow-up appointment with your physician is typically scheduled 2 to 4 weeks after your Final Evaluation.
The second appointment is typically scheduled 4-8 weeks after your Final Evaluation.
These appointments are used to discuss treatment progress and address any questions or concerns. Patients who
live too far from our clinics or who do not continue care with us can do their follow-up appointment over the phone.
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CANCELLATION/RESCHEDULE POLICIES
PLEASE REVIEW AND UNDERSTAND OUR CANCELLATION AND RESCHEDULE POLICIES BELOW:
CANCELLATION POLICY:
Due to the complex nature of our evaluation process, a deposit is required to schedule your appointment(s). This
initial deposit must be paid at the time appointments are scheduled. Your deposit will be applied to the complete
payment of services.
To receive a refund of your initial deposit, you must cancel your first appointment no later than 3 business days
AFTER SCHEDULING your appointment.
RESCHEDULE POLICY:
If you would like to reschedule your appointment, you must notify the clinic no later than 3 business days BEFORE
YOUR FIRST SCHEDULED APPOINTMENT; otherwise, you will forfeit your deposit.
Changes or cancellations of consultations must be made 24 business hours before their scheduled time. For
example, the 24 business hours would require that an appointment for 9:00 AM on Monday be canceled no later
than 9:00 AM the prior Friday to avoid being charged.
PAYMENT INFORMATION:
ACI is a fee-for-service clinic. We require that you pay before (or at the time of) a scheduled appointment. Personal
checks, cashier’s checks, Visa, MasterCard, American Express, Discover, and Care Credit are accepted. We do not
accept cash.
INSURANCE/MEDICARE:
Amen Clinics is an out-of-network provider. We do not bill insurance and are not Medicare, Medicaid, or Medi-Cal
providers. At the end of the evaluation, patients are given a superbill containing applicable diagnosis and billing
codes, which can then be submitted to insurance companies for possible reimbursement. For Medicare, Medicaid,
or Medi-Cal patients, you will not be able to file claims with them, and you will not receive reimbursement. Our
doctors and therapists are not affiliated with any insurance plans or networks. As a result, insurance carriers will
regard fees and treatment incurred at the Amen Clinics as an out-of-network procedure. Please check with your
insurance provider for any mental health benefits.
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FEES AND OTHER EVALUATION OPTIONS
BELOW IS A LIST OF THE DIFFERENT TYPES OF EVALUATION OPTIONS AND THE FEES ASSOCIATED:
FULL EVALUATION | $4,495
Clinical history, two brain SPECT scans, WebNeuro, SCID assessment, evaluation with an ACI physician, two aftercare
appointments with an ACI staff, as well as two 20-25-minute follow-up appointments with your ACI physician.
SINGLE SCAN EVALUATION | $3,315
Same as full but only concentration scan performed
CLINICAL EVALUATION | $1,820
No scans performed
ADD ON TO ANY EVALUATION:
z Comprehensive Labs and Review with an ACI Integrative Physician: $1,499
HALF SESSION APPOINTMENT | $212.50
20-25 minute session
FULL SESSION APPOINTMENT | $425
45-50 minute session
ESTABLISHING CARE APPOINTMENT | $637.50
60-75 minute session
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INSURANCE PROCEDURE CODES
Tax ID: 91-2055998
The following insurance procedure codes have been provided for reference. The fees associated with each procedure
are also listed. Fees are subject to change without notice.
CPT Code Description Fee
SPECT SCANS
78803 Tomographic (SPECT) Scan when completing one scan $1,440
78803 Tomographic (SPECT) Scan when completing two scans $1,310/scan
96146 Psych. Testing (computer-assisted), when completing $155
Concentration Scan
CLINICAL HISTORY
99205 Initial Comprehensive and Management Evaluation $345
90889 Preparation of Initial Report $100
QEEG
95812 QEEG 40 to 60 minutes Varies By Market*
90887 Explanation of Results Varies By Market*
DOCTOR’S EVALUATION
90792 Psychiatric Diagnostic Evaluation $425
90885 Psychiatric Evaluation of Records, Reports, and Tests $75
90887 Interpretation or Explanation of Results $175
90889 Preparation of Final Report $75
96130 Psych. Testing $100
FOLLOW-UP
99242 Office Consultation (20 to 25 minutes) $212.50
99214/90833 Med Management/Therapy (20 to 25 minutes) $212.50
*Prices are subject to change.
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FREQUENTLY ASKED QUESTIONS
WHAT IS THE IV INJECTION AND ARE THERE ANY 2. Family First Discount Plan: We have a family
SIDE EFFECTS? plan that allows you to save more on your
A SPECT scan requires the injection of a very small amount evaluation when booking 2 or more family
of radiopharmaceutical (Ceretec) intravenously. The members at the same time. To learn more, go
medicine we inject is not an iodine based dye. Side effects to www.amenclinics.com/family-discount-plan
are rare, but may include headache, fever, and rash. 3. Care Credit: We offer a financing option through
a third-party company called Care Credit. You
HOW MANY DAYS DO I NEED TO BE AT THE CLINIC? can apply for an account at www.carecredit.com
You should allow 2 to 3 days for the full evaluation. or call 866-893-7864.
These days do not need to be consecutive unless you
live outside the area. DO YOU OFFER PHONE CONSULTATIONS BEFORE
SCHEDULING AN APPOINTMENT?
WHAT IS THE SUCCESS RATE? Yes. If you would like to schedule a consultation with a
At Amen Clinics, on average we treat people who physician, you can do so by calling our Care Center at
have failed more than 3 providers and 5 medications. 888-288-9834. The charge for a 20-30 minute session
In a formal outcome study on over 5,000 patients, is $212.50 and a 45-60 minute session is $425.
after 6 months 76% of patients report significant
improvements. That number climbs to 84% if they CAN MY AMEN CLINICS PHYSICIAN BECOME MY
continued their treatment at Amen Clinics. Many factors REGULAR DOCTOR?
can affect the outcome, such as willingness to follow the This is something you can discuss this with your
treatment plan, age, and severity of symptoms. Amen Clinics physician, and he or she will see if it is
appropriate. If you already have another physician, we
WILL I MEET DR. AMEN PERSONALLY? ask that you discuss this option with your doctor first.
Currently, Dr. Amen is unable to take on new patients,
and his waiting list is closed. You can feel confident WHAT IF I HAVE QUESTIONS AFTER MY
that Dr. Amen has personally handpicked and has EVALUATION?
trained all of our physicians at Amen Clinics. You will have four appointments with your care
team after your evaluation. You can ask questions
DO YOU OFFER ANY DISCOUNTS, PAYMENT PLANS then, and also reach out to your doctor in between
OR FINANCIAL ASSISTANCE? appointments with quick questions. Additionally, we
Yes, we do. From time to time, we offer special are happy to provide a consultation to you or your
promotions and discounts with limited time offers. doctor in the future should additional questions arise.
To be the first to receive these special offers and Fees may apply.
discounts, subscribe to Dr. Amen’s Newsletter at
www.amenclinics.com/newsletter
HERE ARE A FEW DISCOUNTS AND A FINANCING
OPTION.
1. Patient Referral Discount: We offer a 10%
discount for friends and family members of
previous patients that schedule an appointment
with our clinics. The original patient must have
had a completed full evaluation with SPECT.
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CHANGE YOUR BRAIN
CHANGE YOUR LIFE
CLINIC LOCATIONS
ATLANTA
5901 Peachtree-Dunwoody Road, Suite C65
Atlanta, GA 30328
CHICAGO
2333 Waukegan, Suite 150
Bannockburn, IL 60015
DALLAS
7301 N. State Highway 161, Suite 170
Irving, TX 75039
LOS ANGELES
5363 Balboa Blvd., Suite 100
Encino, CA 91316
NEW YORK
16 E 40th Street, 9th Floor
New York, NY 10016
NORTHERN CALIFORNIA
350 N. Wiget Lane, Suite 105
Walnut Creek, CA 94598
NORTHWEST
616 120th Ave NE, Suite C100
Bellevue, WA 98005
ORANGE COUNTY, CA
3150 Bristol Street, Suite 400
Costa Mesa, CA 92626
WASHINGTON, D.C.
10701 Parkridge Blvd., Suite 110
Reston, VA 20191
CORPORATE OFFICE
3150 Bristol Street, Suite 400
Costa Mesa, CA 92626
www.amenclinics.com | 1-888-288-9834
