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GEENENS PSYCHIATRY TEAM OVER 31 YEARS OF EXPERIENCE. ​ LOVE FOR OUR PROFESSION . EXPERTISE. COMMITMENT TO EXCELLENCE. Dr. Douglas L. Geenens is a highly trained mental health professional with over 30 years of experience. Dr. Geenens received his psychiatric training at the famed Menninger Clinic and Harvard Medical School. Throughout his professional training, he has received many awards, including the Seeley Fellowship and the National Laughlin Award. During his professional career, Dr. Geenens has treated thousands of patients in psychotherapy and medication management. He has won numerous awards for his research, teaching, and patient care. Dr. Geenens is passionate about helping patients feel cared for and his goal is to minimize and alleviate suffering to the best of his ability. Dr. Geenens' patients' ratings place him as one of the top psychiatrists in the nation. We are all very honored to be working for Dr. Geenens. OUR PSYCHIATRIST Douglas L . Geenens, D.O. doctorgkc@ gmail.com Kelley O'Conor Morgan is a board-certified Psychiatric Mental Health Nurse Practitioner, graduating with distinction with a Master’s in Nursing. Her educational background also includes dual Bachelor’s in Psychology and Nursing, graduating as magna cum laude. She worked as a board-certified Psychiatric Registered Nurse for five years, treating individuals in pediatric and adult populations with wide ranges of mental health conditions and crises. She is well-versed in therapeutic communication skills and has a deep level of empathy and compassion for her patients. Kelley provides a blend of psychotherapy and medication management and treats all ages and conditions. Kelley's goal is to provide all her patients with holistic and individually-based care, knowing each patient will present with their own unique story, needs, and concerns. We are extremely proud to have Kelley on our team! OUR NURSE PRACTITIONER Kelley O'Conor Morgan kelleyo@geenenspsychiatry.org Irmina Ragauskaite Fisk is board-certified Psychiatric Mental Nurse Practitioner with 7 years of experience in the nursing field. Her most recent work at an acute psychiatric mental health hospital has allowed her to see the impact of severe mental illness on a person's life. Irmina has a genuine passion for improving mental health in individuals by educating them on how to navigate mental illness in their lives through an effective medication management plan. Irmina prides herself in providing ongoing support throughout the patient's personal journey. We are overjoyed to have Irmina on our team! OUR NURSE PRACTITIONER Irmina Ragauskaite Fisk Irminaf@geenenspsychiatry.org Geenens Psychiatry is very proud to introduce to our patients and colleagues our Practice Manager, Ms. Jean Hosseini. She comes to us with a very accomplished professional background in healthcare, business, and information technology. Ms. Hosseini has a Bachelor's Degree in Business Management and Technology and a Master's Degree in Business Administration from Webster University. Ms. Hosseini comes to us with extensive knowledge in operations management, strategic planning, patient advocacy, and revenue cycle analysis. She is a multifaceted problem solver and a strong advocate for the well-being of our patients. We are very delighted to have Jean on our team! OUR PRACTICE MANAGER Jean Hosseini j eanhosseini@geenenspsychiatry.org Daniel Albert is our Patient Services Administrator. He is an alumni of the University of Central Missouri with a BSE in English & Philosophy. Daniel graduated with a 4.0 GPA. Daniel is an advocate of mental health and disabilities and aspires to use his own experiences to help others. He is also an avid writer and reader with a love for learning and empathy. Daniel has outstanding customer service skills and is dedicated to hard work and helping others. With the intention of being consistent and effective at Geenens Psychiatry, Daniel makes a difference for our patients. We are elated to have Daniel on our team! OUR PATIENT SERVICES ADMINISTRATOR Daniel Albert adaniel@geenenspsychiatry.org Dave Geenens is the Chief Financial Officer at Geenens Psychiatry and holds a CPA and MBA. He is a full-time professor in the School of Business at Benedictine College and consults with numerous companies in his spare time. He is the author of four books. In his executive career, Dave has served as President/CEO of three companies. As Dr. Douglas Geenens' twin brother, he shares the desire to help people flourish in the one and only life God has given them. We are thrilled to have Dave on our team! OUR CHIEF FINANCIAL OFFICER Dave Geenens ​

PRIVATE. PROFESSIONAL. PERSONAL. CHILD, ADOLESCENT AND ADULT PSYCHIATRIC SERVICES Geenens Psychiatry, PA 4901 W. 136th St. Leawood, Kansas 66224 Tel. 913-392-2400 Fax 913-276-7274

PSYCHIATRY AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION Please click on the PDF button to fill out the Release of information (ROI). Please fill it out completely. Save it. Upload your saved ROI on the white Upload Button. ROI 2023.pdf Please click on the PDF icon to download the ROI Form and fill it out. Once completed, please upload the completed form. You may also email it to adaniel@geenenspsychiatry or blaireg@geenenspsychiatry.org Please call our office should you have any questions. Upload Completed ROI here Upload supported file (Max 15MB) SUBMIT Thank you for submitting your ROI request.Your request will be processed within 72 business hours.

REQUEST AN APPOINTMENT NEW PATIENTS Patients NEW to Geenens Psychiatry, please click on the button below and fill out the New Patient Form . We will contact you within 24 hours. We are excited to meet you soon! New Patient Intake Form EXISTING PATIENTS If you are currently a patient, please call our office to request to schedule your next appointment with one of our providers. 913-392-2400

A WORD FROM DR. GEENENS

GEENENS PSYCHIATRY FORMS Please select the form you need and submit your request. Your form will be forwarded to your medical provider. New Patient Intake Form Any Forms you need completed by your provider Release of Information Form

TELEMEDICINE Please click on your provider's name or picture for your telemedicine appointment. Your provider will be with you momentarily. If you experience any problems or difficulties please call us immediately at 913-392-2400 Dr. Douglas Geenens Ms. Kelley Morgan O'Conor Ms. Irmina Fisk

Please fill out and submit the New Patient Intake Form. Once completed, our Patient Care Administrator will contact you within 24 hours. NEW PATIENT INTAKE FORM First Name Middle Name Preferred Name DOB Address City Last Name Sex/Preferred Gender State Zip Code Phone Number Email Name of Parent/Legal Guardian (If patient under 18 or Assigned Legal Guardian) How did you hear about us? Reason for doctor's visit Name of person or organization who referred you to us ID AND INSURANCE CARD UPLOAD Please upload your ID and insurance card FRONT & BACK. Insurance information is used for Prior Authorization purposes only. Upload ID Upload supported file (Max 15MB) Ins. Card/Front Upload supported file (Max 15MB) Ins. Card/Back Upload supported file (Max 15MB) PHARMACY INFORMATION Pharmacy you want on file for your prescriptions (if none, please type None). Pharmacy Pharmacy Addess Pharmacy Phone I agree to Company Policy View terms here I agree to Controlled Medication Agreement View terms here Submit Thank you for submitting this form! We will call you within 24 hours.

A FEW OF OUR TESTIMONIALS "Dr. Geenens, I just wanted you to know I appreciate you and your office staff for doing an awesome job on always helping me with whatever I've needed help with. A ll of you respond to me in a quick manner and I'm sure you guys have a lot of patients to deal with. Your hard work and your kindness for people who need kindness in their lives definitely does not go unnoticed. Thank you so much." K.C. ​ My appointment with Dr. Geenens was amazing, as it always is. I love Dr. Geenens, and the mutual respect he gives me in return is unrenowned. He listens when it’s time to listen. He’s excited about my accomplishments and offers sound advice at my failures. It means the world that at least one physician in this world still cares. B.B. ​ ​ "Dr. Geenens continued to surface as one of the best practitioners in his field during extensive research I conducted, and he has lived up to that reputation. He is both a psychiatrist and a psychologist, which has been invaluable. He's a great listener as well as a great advisor who has helped me navigate through some very difficult situations. His knowledge about the medical field in general has been a valuable source. Kind, funny, practical, caring and extremely intelligent are words that come to mind in describing Dr. Geenens. I highly recommend him." -J.H.D.

Request for Paperwork To Be Completed First Name Email Last Name Form Deadline Please upload the form you need . Your form will be forwarded to the medical provider. If there is no document, simply add your instructions below. Upload Document Upload supported file (Max 15MB) Additional Instructions Submit Thank you for submitting. Your request will be forwarded to your medical provider.

REFILL REQUEST Please fill out the Refill Request For below. If you are requesting a refill on your medication, or if you are changing pharmacies (Due to the national shortage of some medications, please ensure your pharmacy does have your medication in stock before you request a change in pharmacy.) PLEASE NOTE Your prescription will be submitted electronically to your pharmacy within 24 hours once it has been approved by your provider. Thank you for your patience. REFILL REQUEST FORM PATIENT INFORMATION Patient Name DOB Patient Last Name Email PHARMACY INFORMATION Pharmacy Address Last refill date Medication Requested Medication Dose Additional Instructions Submit Thank you for submitting your request! It will be submitted electronically to your pharmacy within 24 hours onc e it has been approved by your provider.

Geenens Psychiatry Policy INSURANCE ​ Geenens Psychiatry is a private-pay psychiatric clinic. Our office is not affiliated with or in-network with any insurance companies, including Medicare or Medicaid. TELEPHONE/TELEMEDICINE APPOINTMENTS ​ Geenens Psychiatry provides in-person, video, and telephone appointments. If your appointment is conducted via Telehealth (video), please click the link provided in your email/text reminder 5-10 minutes before your video appointment. If your appointment is conducted via telephone call, your provider will call you at the time of your appointment. Patients who are late for their appointment will be asked to reschedule and are responsible for payment for that missed appointment. Being late disrupts the allotted time scheduled specifically scheduled for you. The full allotted time for the appointment is necessary for your provider to make a thorough evaluation and properly document your visit. If the patient misses the appointment or is late for the appointment, the patient will can request another appointment provided there is not a balance for the missed appointment. ​ CANCELLATION POLICY If you must change/cancel your appointment, we require at least 24 hours’ notice. Patients who cancel with less than 24 hours' notice before their appointment are responsible for the full payment. New Patients, if you must change/cancel your appointment, we require New Patients to provide at least 48 hours for their New Patient Intake appointment since it is for one (1) hour. New Patients who cancel with less than 48 hours' notice before their initial Intake appointment are responsible for the full payment. ​ MISSED APPOINTMENTS (NO-SHOW, NON-CANCELLED) ​​ Patients who do not attend their scheduled appointment are responsible for the payment of that appointment. Patients may reschedule an appointment once their balance is paid off for the missed appointment. ​ NEW PATIENTS (INTAKE FEE AND DEPOSIT) The fee for a new patient intake session is $250. A $125 deposit is required in order to schedule an appointment. The remaining $125 will be processed automatically on the date of the appointment. The deposit is fully refundable provided the patients honors the 48-hour notice prior to the appointment. If no timely notice is given, or if the patient misses the appointment, the deposit is non-refundable and the remaining $125 for the Intake is also due. Patients cannot schedule an appointment if there is an outstanding balance. ​ PAYMENT Payment is due the day of your appointment. Payments are processed automatically by our system on the day of your appointment. There is an automatic fee of $10 for late payments after the day of the appointment. We have payment options available for established patients. We accept credit cards, checks, money orders, HSA cards, and cash. ​ REQUIREMENT OF A CARD ON FILE A card on file is required for payments. Payment for your appointment is processed automatically by our system on the day of your appointment. The card is used to process payment if the patient missed and an appointment or has a late cancellation. The card is used to process payment of administrative fees such as letters, forms, administrative documents, etc. at the patient's request. ​ STANDARD OF CARE As part of the Standard of Care, patients who are prescribed Schedule II substances are required to be seen at least every 90 days. If a patient requests a script outside of the 90-day window, due to a missed appointment or cancelled appointment, Geenens Psychiatry, PA will review the request and consider each request on a case by case basis. There is a fee of $50 for a one-month courtesy script. ​ We would like to thank you for choosing Geenens Psychiatry, PA. We are committed to responding to patients the same day or within 24 hours. We value you and strive to provide the best care with integrity and professionalism. ​ This document was written and developed by Geenens Psychiatry, PA and is the intellectual property of Geenens Psychiatry. Copying any or all portion of it is strictly prohibited and it is illegal. (Copyright 2019).