Common Contracts
1 similar Informed Consent Agreement contracts
INFORMED CONSENTInformed Consent Agreement • September 29th, 2015
Welcome to Ascent Psychotherapy Center (APC). This 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 federal law that provides privacy protections and client 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. Although these documents are long and sometimes complex, it is very important that you read them carefully. We can discuss any questions you have about the 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 APC unless we have taken action in reliance on this agreement or if you have not satisfied any financial obligations you have incurred.
