Common use of Client Privilege Clause in Contracts

Client Privilege. The information disclosed by Client, as well as any records created, is subject to the psychotherapist- client privilege. The psychotherapist-client privilege results from the special relationship between Therapist and Client in the eyes of the law. It is akin to the attorney-client privilege or the doctor-patient privilege. Typically, the client is the holder of the psychotherapist-client privilege. If Therapist received a subpoena for records, deposition testimony, or testimony in a court of law, Therapist will assert the psychotherapist-client privilege on Client's behalf. When a client is a minor child, the holder of the psychotherapist-client privilege is either the minor, a court appointed guardian, or minor’s counsel. Parents typically do not have the authority to waive the psychotherapist-client privilege for their minor children, unless given such authority by a court of law. Representative is encouraged to discuss any concerns regarding the psychotherapist-client privilege with his/her attorney. Client, or Representative, should be aware that he/she might be waiving the psychotherapist-client privilege if he/she makes his/her mental or emotional state an issue in a legal proceeding. Client, or Representative, should address any concerns he/she might have regarding the psychotherapist-client privilege with his/her attorney. The usual and customary fee for service is $120.00 per 50- minute session and $150.00 per 90- minute session. Therapist reserves the right to periodically adjust this fee. Representative will be notified of any fee adjustment in advance. In addition, this fee may be adjusted by contract with insurance companies, managed care organizations, or other third-party payors, or by agreement with Therapist. From time-to-time, Therapist may engage in telephone contact with Client or Representative for purposes other than scheduling sessions. Representative is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. In addition, from time-to-time, Therapist may engage in telephone contact with third parties at the request of Client or Representative and with the advance written authorization of Client or Representative. Representative is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. Representative is expected to pay for services at the time services are rendered. Therapist accepts cash, checks, and major credit cards.

Client Privilege. The information disclosed by Client, as well as any records created, is subject to the psychotherapist- psychotherapist-client privilege. The psychotherapist-client privilege results from the special relationship between Therapist and Client in the eyes of the law. It is akin to the attorney-client privilege or the doctor-patient client privilege. Typically, the client is the holder of the psychotherapist-psychotherapist- client privilege. If Therapist received a subpoena for records, deposition testimony, or testimony in a court of law, Therapist will assert the psychotherapist-client privilege on Client's behalf’s behalf until instructed, in writing, to do otherwise by Client or Client’s representative. When a client is a minor child, the holder of the psychotherapist-client privilege is either the minor, a court appointed guardian, or minor’s counsel. Parents typically do not have the authority to waive the psychotherapist-client privilege for their minor children, unless given such authority by a court of law. Representative is encouraged to discuss any concerns regarding the psychotherapist-client privilege with his/her attorney. Client, or Representative, Client should be aware that he/she might be waiving the psychotherapist-client privilege if he/she makes his/her mental or emotional state an issue in a legal proceeding. Client, or Representative, Client should address any concerns he/she might have regarding the psychotherapist-client privilege with his/her attorney. The usual and customary fee for service is $120.00 150 per 50- minute session and $150.00 per 90- 45-minute session. Sessions longer than 45- minutes are charged for the additional time pro rata. Therapist reserves the right to periodically adjust this fee. Representative Client will be notified of any fee adjustment in advance. In addition, this fee may be adjusted by contract with insurance companies, managed care organizations, or other third-third- party payors, or by agreement with Therapist. The agreed upon fee between Therapist and Client will be . From time-to-time, Therapist may engage in telephone contact with Client or Representative for purposes other than scheduling sessions. Representative Client is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. In addition, from time-to-time, Therapist may engage in telephone contact with third parties at the Client’s request of Client or Representative and with the Client’s advance written authorization of Client or Representativeauthorization. Representative is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. Representative is Clients are expected to pay for services at the time services are rendered. Therapist accepts cash, checks, debit cards and major credit cards.

Client Privilege. The information disclosed by Client, as well as any records created, is subject to the psychotherapist- client psychotherapist-Client privilege. The psychotherapist-client Client privilege results from the special relationship between Therapist and Client in the eyes of the law. It is akin to the attorney-client privilege or the doctor-patient Client privilege. Typically, the client Client is the holder of the psychotherapist-client psychotherapist- Client privilege. If Therapist received a subpoena for records, deposition testimony, or testimony in a court of law, Therapist will assert the psychotherapist-client Client privilege on Client’s behalf until instructed, in writing, to do otherwise by a person with the authority to waive the privilege on Client's behalf. When a client Client is a minor child, the holder of the psychotherapist-client Client privilege is either the minor, a court appointed guardian, or a minor’s 's counsel. Parents typically do not have the authority to waive the psychotherapist-client Client privilege for their minor children, unless given such authority by a court of law. Representative is encouraged to discuss any concerns regarding the psychotherapist-client Client privilege with his/her attorney. Client, or Representative, should be aware that he/she might be waiving the psychotherapist-client Client privilege if he/she makes his/her mental or emotional state an issue in a legal proceeding. Client, or Representative, should address any concerns he/she might have regarding the psychotherapist-client psychotherapist- Client privilege with his/her attorney. The usual and customary fee for service is $120.00 130 per 50- 50-minute session of Individual Therapy and $150.00 per 90- minute sessionFamily Therapy. Sessions longer than 50-minutes are charged for the additional time pro rata. Most of the work Therapist does with a minor child is going to be in the Family Therapy format, and may be split with the Client and Representatives, and/or Client together with Representatives and other family members. These sessions will all be billed as Family Therapy. Therapist reserves the right to periodically adjust this fee. Representative will be notified of any fee adjustment in advance. In addition, this fee may be adjusted by contract with insurance companies, managed care organizations, or other third-party payors, or by agreement with Therapist. The agreed upon fee between Therapist and Representative is [insert usual and customary fee, or other agreed upon fee] . Therapist reserves the right to periodically adjust fee. Representative will be notified of any fee adjustment in advance. From time-to-time, Therapist may engage in telephone contact with Client or Representative for purposes other than scheduling sessions. Representative is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten fifteen minutes. In addition, from time-to-time, Therapist may engage in telephone contact with third parties at the request of Client or Representative and with the advance written authorization of Client or Representative. Representative is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten fifteen minutes. Representative is expected to pay for services at the time services are rendered. Therapist accepts cash, checks, and major credit cards, including Visa, Mastercard, Discover, and American Express. There will be a $25 fee assessed on all returned or cancelled checks. If Representative has a returned or cancelled check, Therapist may request that Representative use a different method of payment for future services.

Client Privilege. The information disclosed by the Client, as well as any records created, is subject to the psychotherapist- psychotherapist-client privilege. The psychotherapist-client privilege results from the special relationship between the Therapist and the Client in the eyes of the law. It is akin to the attorney-client privilege or the doctor-patient client privilege. Typically, the client Client is the holder of the psychotherapist-client privilege. If the Therapist received a subpoena for records, deposition testimony, or testimony in a court of law, the Therapist will assert the psychotherapist-client privilege on the Client's behalf’s behalf until instructed, in writing, to do otherwise by the Client or the Client’s representative. When a client is a minor child, the holder of the psychotherapist-client privilege is either the minor, a court appointed guardian, or minor’s counsel. Parents typically do not have the authority to waive the psychotherapist-client privilege for their minor children, unless given such authority by a court of law. Representative is encouraged to discuss any concerns regarding the psychotherapist-client privilege with his/her attorney. Client, or Representative, The Client should be aware that he/she might be waiving the psychotherapist-client privilege if he/she makes his/her mental or emotional state an issue in a legal proceeding. Client, or Representative, The Client should address any concerns he/she might have regarding the psychotherapist-client privilege with his/her attorney. The usual and customary fee for service is $120.00 per 50- minute session and $150.00 per 90- for a 50 minute session. Sessions longer than 50 minutes are charged for the additional time pro rata. The Therapist reserves the right to periodically adjust this fee. Representative The Client will be notified of any fee adjustment in advance. In addition, this fee may be adjusted by contract with insurance companies, managed care organizations, or other third-party payorspayers, or by agreement with the Therapist. The agreed upon fee between the Therapist and the Client is . The Therapist reserves the right to periodically adjust fee. The Client will be notified of any fee adjustment in advance. From time-to-time to time, the Therapist may engage in telephone contact with the Client or Representative for purposes other than scheduling sessions. Representative The Client is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. In addition, from time-to-time, the Therapist may engage in telephone contact with third parties at the Client’s request of Client or Representative and with the Client’s advance written authorization of authorization. The Client or Representative. Representative is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. Representative is Clients are expected to pay for services at the time services are rendered. The Therapist accepts cash, cash and checks, and major credit cards.

Client Privilege. The information disclosed by Client, as well as any records created, is subject to the psychotherapist- psychotherapist-client privilege. The psychotherapist-client privilege results from the special relationship between Therapist and Client in the eyes of the law. It is akin to the attorney-client privilege or the doctor-patient client privilege. Typically, the client is the holder of the psychotherapist-client privilege. If Therapist received a subpoena for records, deposition testimony, or testimony in a court of law, Therapist will assert the psychotherapist-client privilege on Client's behalf’s behalf until instructed, in writing, to do otherwise by Client or Client’s representative. When a client is a minor child, the holder of the psychotherapist-client privilege is either the minor, a court appointed guardian, or minor’s counsel. Parents typically do not have the authority to waive the psychotherapist-client privilege for their minor children, unless given such authority by a court of law. Representative is encouraged to discuss any concerns regarding the psychotherapist-client privilege with his/her attorney. Client, or Representative, Client should be aware that he/she might be waiving the psychotherapist-client privilege if he/she makes his/her mental or emotional state an issue in a legal proceeding. Client, or Representative, Client should address any concerns he/she might have regarding the psychotherapist-client privilege with his/her attorney. The usual and customary fee for service is $120.00 250 per 50- 50-minute session and $150.00 per 90- minute sessionfor individual therapy or couples therapy. Sessions longer than 50-minutes are charged for the additional time pro rata. Therapist reserves the right to periodically adjust this fee. Representative Client will be notified of any fee adjustment in advance. In addition, this fee may be adjusted by contract with insurance companies, managed care organizations, or other third-party payors, or by agreement with Therapist. From time-to-time, Therapist may engage in telephone contact with Client or Representative for purposes other than scheduling sessions. Representative Client is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. In addition, from time-to-time, Therapist may engage in telephone contact with third parties at the Client’s request of Client or Representative and with the Client’s advance written authorization of authorization. Client or Representative. Representative is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. Representative is Clients are expected to pay for services at the time services are rendered. Therapist accepts cash, checks, cash and major personal checks as well as credit cards. Clients may not use credit cards for reduced fee sessions.

Client Privilege. The information disclosed by Client, as well as any records created, is subject to the psychotherapist- psychotherapist-client privilege. The psychotherapist-client privilege results from the special relationship between Therapist and Client in the eyes of the law. It is akin to the attorney-client privilege or the doctor-patient client privilege. Typically, the client is the holder of the psychotherapist-client privilege. If Therapist received a subpoena for records, deposition testimony, or testimony in a court of law, Therapist will assert the psychotherapist-client privilege on Client's behalf’s behalf until instructed, in writing, to do otherwise by Client or Client’s representative. When a client is a minor child, the holder of the psychotherapist-client privilege is either the minor, a court appointed guardian, or minor’s counsel. Parents typically do not have the authority to waive the psychotherapist-client privilege for their minor children, unless given such authority by a court of law. Representative is encouraged to discuss any concerns regarding the psychotherapist-client privilege with his/her attorney. Client, or Representative, Client should be aware that he/she might be waiving the psychotherapist-client privilege if he/she makes his/her mental or emotional state an issue in a legal proceeding. Client, or Representative, Client should address any concerns he/she might have regarding the psychotherapist-client privilege with his/her attorney. The usual and customary fee for service is $120.00 120 per 50- minute session and $150.00 per 90- 45-minute session. Sessions longer than 45-minutes are charged for the additional time pro rata. Therapist reserves the right to periodically adjust this fee. Representative Client will be notified of any fee adjustment in advance. In addition, this fee may be adjusted by contract with insurance companies, managed care organizations, or other third-party payors, or by agreement with Therapist. The agreed upon fee between Therapist and Client is [insert usual and customary fee, or other agreed upon fee] ______________. Therapist reserves the right to periodically adjust fee. Client will be notified of any fee adjustment in advance. From time-to-time, Therapist may engage in telephone contact with Client or Representative for purposes other than scheduling sessions. Representative Client is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. In addition, from time-to-time, Therapist may engage in telephone contact with third parties at the Client’s request of Client or Representative and with the Client’s advance written authorization of authorization. Client or Representative. Representative is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. Representative is Clients are expected to pay for services at the time services are rendered. Therapist accepts cash, checks, debit cards and major credit cards. Client is responsible for any and all fees not reimbursed by his/her insurance company, managed care organization, or any other third-party payor. Client is responsible for verifying and understanding the limits of his/her coverage, as well as his/her co-payments and deductibles. Therapist is a contracted provider with the following companies: Anthem/Blue Cross, Magellan/Blue Shield, Value Options/Beacon, Military One Source, Humana, The Xxxxxx Group and some EAPs and has agreed by contract to a specified fee. Other insurance companies may have “out of network” clauses that will allow for reimbursement. If Client intends to use benefits of his/her health insurance policy, Client agrees to inform Therapist in advance.

Client Privilege. The information disclosed by Client, as well as any records created, is subject to the psychotherapist- client psychotherapist Client privilege. The psychotherapist-client Client privilege results from the special relationship between Therapist and Client in the eyes of the law. It is akin to the attorney-client privilege or the doctor-patient Client privilege. Typically, the client Client is the holder of the psychotherapist-client Client privilege. If Therapist received a subpoena for records, deposition testimony, or testimony in a court of law, Therapist will assert the psychotherapist-client Client privilege on Client's behalf’s behalf until instructed, in writing, to do otherwise by Client or Client’s representative. When a client is a minor child, the holder of the psychotherapist-client privilege is either the minor, a court appointed guardian, or minor’s counsel. Parents typically do not have the authority to waive the psychotherapist-client privilege for their minor children, unless given such authority by a court of law. Representative is encouraged to discuss any concerns regarding the psychotherapist-client privilege with his/her attorney. Client, or Representative, Client should be aware that he/she might be waiving the psychotherapist-client psychotherapist- Client privilege if he/she makes his/her mental or emotional state an issue in a legal proceeding. Client, or Representative, Client should address any concerns he/she might have regarding the psychotherapist-client Client privilege with his/her attorney. The usual and customary fee for service is $120.00 175 per 50- minute session and $150.00 per 90- 45-minute session. Sessions longer than 45-minutes are charged for the additional time pro rata. Therapist reserves the right to periodically adjust this fee. Representative Client will be notified of any fee adjustment in advance. In addition, this fee may be adjusted by contract with insurance companies, managed care organizations, or other third-third- party payors, or by agreement with Therapist. The agreed upon fee between Therapist and Client is . Therapist reserves the right to periodically adjust his fee. Client will be notified of any fee adjustment in advance. A Client’s appointment is reserved exclusively for the Client. Client will be charged the full fee per session for any missed or cancelled appointments. Client Initials: Unless you have made special arrangements with Therapist, if Client misses two or more appointments in a row Therapist may not be able to hold the appointment time and Client may lose their time slot. From time-to-time, Therapist may engage in telephone contact with Client or Representative for purposes other than scheduling sessions. Representative Client is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. In addition, from time-to-time, Therapist may engage in telephone contact with third parties at the Client’s request of Client or Representative and with the Client’s advance written authorization of authorization. Client or Representative. Representative is responsible for payment of the agreed upon fee (on a pro rata basis) for any telephone calls longer than ten minutes. Representative All past due accounts which have not had payment activity for 30 days or more will be reviewed and may be referred to a collection agency. Collection fees may be added to these accounts. The Client, or responsible party, agrees to pay Xxxxxx Xxxxxxxx, MA, LMFT, any reasonable costs of collection, plus attorney fees and court costs in the event that legal action is required for collection of fees. Like many other mental health providers, Therapist has formal relationships only with some managed health care providers. These are Aetna and MHN. Therapist does accept referrals only from these managed health care providers and will otherwise only be accepting private pay clients. The reasons for this include the overwhelming administrative time spent in dealing with insurance companies and financial concerns. This means private pay clients are expected to pay full fee at the time services are rendered while managed health care clients are expected to pay their co-pay. A private pay client may wish to submit statements to their insurance companies, since some will provide limited reimbursement for “off-plan providers.” If Client submits a bill for reimbursement, Client needs to make it clear that the Client/Member is to be reimbursed, not the provider. Clients are expected to pay for services at the time services are rendered. Therapist accepts cash, checks, and major select credit cards.