Common Contracts
2 similar Clinician - Patient Service Agreement contracts
Clinician - Patient Service AgreementClinician - Patient Service Agreement • November 13th, 2024
This document contains important information about our professional services and business policies. It accompanies the information you were given about the Health Insurance Portability and Accountability Act (HIPAA). It is important that you read them carefully and understand them. We can discuss any questions you have. When you sign this document, it will represent an Agreement between us. You may revoke this Agreement in writing at any time. That revocation will be binding on Psychology Resources unless we have taken action in reliance on it; if there are obligations imposed on us by your health insurer in order to process or substantiate claims made under your policy; or if you have not satisfied any financial obligations you have incurred.
Clinician - Patient Service AgreementClinician - Patient Service Agreement • February 8th, 2024
This document contains important information about our professional services and business policies. It accompanies the information you were given about the Health Insurance Portability and Accountability Act (HIPAA). It is important that you read them carefully and understand them. We can discuss any questions you have. When you sign this document, it will represent an Agreement between us. You may revoke this Agreement in writing at any time. That revocation will be binding on Psychology Resources unless we have taken action in reliance on it; if there are obligations imposed on us by your health insurer in order to process or substantiate claims made under your policy; or if you have not satisfied any financial obligations you have incurred.
