Common Contracts
2 similar General Information and Psychological Services Agreement contracts
General Information and Psychological Services AgreementGeneral Information and Psychological Services Agreement • May 2nd, 2021
Welcome to Warner & Associates, LLC, a psychological services practice, owned by Beth S. Warner, Ph.D., that provides psychotherapy and psychological evaluations. We appreciate your trust and the opportunity to assist you. Maryland law requires that we provide you with this information, and that we obtain your signature acknowledging that we have done so. This document (the Agreement) contains important information about our professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a new federal law that provides new privacy protections, and new patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operations. HIPAA requires that we provide you with a Notice of Policies and Practices to Protect the Privacy of Patient Health Information (the Notice) for use and disclosure of PHI for treatment,
General Information and Psychological Services AgreementGeneral Information and Psychological Services Agreement • July 12th, 2018
Welcome to Warner & Associates, LLC, a psychological services practice, owned by Beth S. Warner, Ph.D., that provides psychotherapy and psychological evaluations. We appreciate your trust and the opportunity to assist you. Maryland law requires that we provide you with this information, and that we obtain your signature acknowledging that we have done so. This document (the Agreement) contains important information about our professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a new federal law that provides new privacy protections, and new patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operations. HIPAA requires that we provide you with a Notice of Policies and Practices to Protect the Privacy of Patient Health Information (the Notice) for use and disclosure of PHI for treatment,
