Common Contracts
3 similar Therapist-Patient Services Agreement contracts
Nancy McReynolds, Ph.D., LPC, LADC, CEDS, ATR Licensed Alcohol & Drug Counselor – Certified Eating Disorders Specialist Licensed Professional CounselorTherapist-Patient Services Agreement • November 29th, 2020
Welcome to my practice. This agreement contains important information about my professional services and business policies. HIPAA requires that I provide you with a Notice of Privacy Practices for use and disclosure of PHI for treatment, payment and health care operations. A copy of such privacy notice is posted in the waiting room. A printed copy will be provided at your request. The law requires that I obtain your signature acknowledging that I have provided you with this information.
Ann Benjamin, M.Ed. Inc. Licensed Professional CounselorTherapist-Patient Services Agreement • November 29th, 2020
Welcome to my practice. This agreement contains important information about my professional services and business policies. HIPAA requires that I provide you with a Notice of Privacy Practices for use and disclosure of PHI for treatment, payment and health care operations. A copy of such privacy notice is posted in the waiting room. A printed copy will be provided at your request. The law requires that I obtain your signature acknowledging that I have provided you with this information.
Moreen W. Foster, M.A.P.C.C. Licensed Professional CounselorTherapist-Patient Services Agreement • November 12th, 2020
Welcome to my practice. This agreement contains important information about my professional services and business policies. HIPAA requires that I provide you with a Notice of Privacy Practices for use and disclosure of PHI for treatment, payment and health care operations. A copy of such privacy notice is posted in the waiting room. A printed copy will be provided at your request. The law requires that I obtain your signature acknowledging that I have provided you with this information.
