Common Contracts
1 similar Agreement for Psychological Services contracts
Agreement for Psychological ServicesAgreement for Psychological Services • January 28th, 2022
Welcome to my practice. As a psychologist, I am required by law to provide you with certain information before we begin psychotherapy. This Agreement contains important information about my professional services and about a federal law that provides for patient rights and privacy protections with regard to the use and disclosure of Protected Health Information (PHI). The Health Insurance Portability and Accountability Act (HIPAA), requires that you sign this “Agreement for Psychological Services” and that I have provided you with a copy of my “Policies and Practices to Protect the Privacy of your Health Information.” This Policy further explains HIPAA and the protection of your personal health information. I apologize for the length and complexity of these documents but the law requires that I outline your rights in this detail. Please ask about anything that is unclear. Your signature represents an agreement between us. You can revoke this Agreement in writing at any time. That revoca
