Common Contracts
2 similar Consent and Service Agreement contracts
Consent and Service AgreementConsent and Service Agreement • August 7th, 2024
Welcome to your first session at my practice. This document contains important information about my professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. Please review carefully. When you sign this document, it will also represent an agreement between us. We can discuss any questions you have when you sign them or at any time in the future.
Charu Chandra, LCPCConsent and Service Agreement • November 25th, 2018
Welcome to your first session at my practice. This document contains important information about my professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. Please review carefully. When you sign this document, it will also represent an agreement between us. We can discuss any questions you have when you sign them or at any time in the future.
