Common Contracts
2 similar Informed Consent Agreement for Psychotherapy Services contracts
Karen Osterle, MSSA, LICSWInformed Consent Agreement for Psychotherapy Services • May 18th, 2023
Welcome to my practice. Your first visit to a new therapist is very important. Please take time to read this document carefully and let me know if you have any questions or need more information. When you sign this document, it will represent an agreement between us.
Karen Osterle, MSSA, LICSWInformed Consent Agreement for Psychotherapy Services • June 7th, 2021
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 with regard to the use and disclosure of your protected health information used for the purposes of treatment, payment, and health care operations. In compliance with this law, I am providing you with a more detailed (HIPAA) Notice of Privacy Practices, which explains this in much greater detail. We can, and should, discuss any questions you have about this agreement and/or the accompanying (HIPAA) Notice of Privacy Practices at any time. After reviewing this information, please sign this form, and return it to me in its entirety. You may revoke this agreement in writing at any time.
