Common Contracts
1 similar Patient Services Agreement contracts
Richard L. Benson, Ph.D., P.A. Licensed PsychologistPatient Services Agreement • September 3rd, 2019
Welcome to my practice. This document (the Agreement) contains important information about my professional services and business policies. It also contains summary infonnation about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights with regard to the use and disclosure of your Protected Health lnfonnation (PHI) used for the purpose of treatment, payment, and health care operations. HIPAA requires that I provide you with a Notice of Privacy Practices (the Notice), which is listed under Fom1s on my website, www.bensonpsvc.com, which explains HIPAA and its application to your personal health infonnatio n. The law requires that l obtain your signature acknowledging that I have provided you access to this information prior to the beginning of psychotherapy (you will attest to this on the Signature/Acceptance Page). Although these documents are long and complex, it is very imp01tant that you read them carefully
