Common Contracts
5 similar Psychotherapist-Client Services Agreement contracts
PSYCHOTHERAPIST-CLIENT SERVICES AGREEMENTPsychotherapist-Client Services Agreement • March 30th, 2024
This document contains important information about my professional services and business policies. When you sign this information, it represents an agreement between us. You may revoke this Agreement in writing at any time. This document also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protection and patient rights about the use and disclosure of Protected Health Information (PHI). HIPAA requires that I provide you with a Notice of Privacy Practices for using and disclosing PHI for the purposes of treatment, payment, and health care operations. The required Notice is attached to this agreement. The law requires that I obtain your signature acknowledging that I have provided you with this information.
PSYCHOTHERAPIST-CLIENT SERVICES AGREEMENTPsychotherapist-Client Services Agreement • December 14th, 2022
This document contains important information about my professional services and business policies. When you sign this information, it represents an agreement between us. You may revoke this Agreement in writing at any time. This document also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protection and patient rights about the use and disclosure of Protected Health Information (PHI). HIPAA requires that I provide you with a Notice of Privacy Practices for using and disclosing PHI for the purposes of treatment, payment, and health care operations. The required Notice is attached to this agreement. The law requires that I obtain your signature acknowledging that I have provided you with this information.
PSYCHOTHERAPIST-CLIENT SERVICES AGREEMENTPsychotherapist-Client Services Agreement • August 18th, 2022
This document contains important information about my professional services and business policies. When you sign this information it represents an agreement between us. You may revoke this Agreement in writing at any time. This document also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protection and patient rights with regard to the use and disclosure of Protected Health Information (PHI). HIPAA requires that I provide you with a Notice of Privacy Practices for using and disclosing PHI for the purposes of treatment, payment, and health care operations. The required Notice is attached to this agreement. The law requires that I obtain your signature acknowledging that I have provided you with this information.
PSYCHOTHERAPIST-CLIENT SERVICES AGREEMENTPsychotherapist-Client Services Agreement • August 14th, 2021
This document contains important information about my professional services and business policies. When you sign this information it represents an agreement between us. You may revoke this Agreement in writing at any time. This document also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protection and patient rights with regard to the use and disclosure of Protected Health Information (PHI). HIPAA requires that I provide you with a Notice of Privacy Practices for using and disclosing PHI for the purposes of treatment, payment, and health care operations. The required Notice is attached to this agreement. The law requires that I obtain your signature acknowledging that I have provided you with this information.
PSYCHOTHERAPIST-CLIENT SERVICES AGREEMENTPsychotherapist-Client Services Agreement • December 27th, 2019
This document contains important information about my professional services and business policies. When you sign this information it represents an agreement between us. You may revoke this Agreement in writing at any time. This document also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protection and patient rights with regard to the use and disclosure of Protected Health Information (PHI). HIPAA requires that I provide you with a Notice of Privacy Practices for using and disclosing PHI for the purposes of treatment, payment, and health care operations. The required Notice is attached to this agreement. The law requires that I obtain your signature acknowledging that I have provided you with this information.
