Common Contracts
2 similar Consent for Treatment contracts
TRUE CONNECTIONS COUNSELING, PLLCConsent for Treatment • July 15th, 2019
This document/agreement contains important information about 1) our professional services, 2) summary information about the Health Insurance Portability and Accountability Act (HIPAA) and confidentiality, and 3) our business practices. Although a bit long and complex, it is important that you read it carefully and ask any questions you might have today or before our next session. Your clinician will give you a copy to take home. When you sign this document, it will represent an agreement between you and your clinician. However, you may revoke this agreement in writing at any time. That revocation will be binding unless a) your clinician has already taken action in reliance on it, b) has legal obligations imposed on it by a court of jurisdiction, or c) if you have not satisfied financial obligations you have incurred.
Consent for TreatmentConsent for Treatment • June 24th, 2016
This document/agreement contains important information about 1) our professional services, 2) summary information about the Health Insurance Portability and Accountability Act (HIPAA) and confidentiality, and 3) our business practices. Although a bit long and complex, it is important that you read it carefully and ask any questions you might have today or before our next session. Your clinician will give you a copy to take home. When you sign this document, it will represent an agreement between you and your clinician. However, you may revoke this agreement in writing at any time. That revocation will be binding unless a) your clinician has already taken action in reliance on it, b) has legal obligations imposed on it by a court of jurisdiction, or c) if you have not satisfied financial obligations you have incurred.
