Common Contracts
1 similar Psychotherapist-Patient Services Agreement contracts
PSYCHOTHERAPIST-PATIENT SERVICES AGREEMENTPsychotherapist-Patient Services Agreement • August 9th, 2020
Welcome to our practice. This document contains important information about our professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA) and new patient rights with regard to the use and disclosure of your Protected Health Information (PHI). Please feel free to ask any questions about our policies and procedures. When you sign this document, it will also represent an agreement between us. You may revoke this Agreement in writing at any time. That revocation will be binding on us 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.
