Agreement for Psychological ServicesAgreement for Psychological Services • July 7th, 2021
AGREEMENT FOR PSYCHOLOGICAL SERVICESAgreement for Psychological Services • August 28th, 2024
This agreement contains important information about my 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 (PHI) used for the purpose of treatment, payment, and health care operations. HIPAA requires that I provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of PHI for treatment, payment and health care operations. The Notice, which was given with this Agreement, explains HIPAA and its application to your personal health information in greater detail. The law requires that I obtain your signature acknowledging that I have provided you with this information. When you sign this document, it will represent an agreement between us about our work together and that you have received HIPAA information. You may revoke this Agreement in w
Agreement for Psychological ServicesAgreement for Psychological Services • November 3rd, 2014
Welcome to GCA. This Agreement contains important information about our professional services and business policies.
AGREEMENT FOR PSYCHOLOGICAL SERVICESAgreement for Psychological Services • July 2nd, 2019
Formerly known as Grace Blocher, Ph.D & Associates, LLC., since 2015, our practice underwent a name change in June of 2018 to Graceway Psychology Group, LLC. We are operating under both names during the transition period until the former name is dissolved.
Misty K. Hook, Ph.D.Agreement for Psychological Services • July 13th, 2014
This document (the Agreement) 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 (PHI) used for the purpose of treatment, payment, and health care operations. When you sign this document, it will also represent an agreement between us and your understanding of the limitations on confidentiality.
Agreement for Psychological ServicesAgreement for Psychological Services • April 1st, 2020
A clear understanding of the various arrangements for intakes, assessments, consulta- tions, and psychotherapy can help you avoid any misunderstandings that might impede progress.
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
AGREEMENT FOR PSYCHOLOGICAL SERVICESAgreement for Psychological Services • August 2nd, 2020
This document outlines for clients my qualifications, treatment philosophy, methods and service policies. It is important to note that it is your right to choose the appropriate provider and treatment that is suitable for your needs. To help facilitate your choice and outline the work we will do together, this document provides general information about my psychology practice.
Psychological Sunrise Center, PLLC Dr. Dina Reimer, Psy.D.Agreement for Psychological Services • October 1st, 2013
This agreement 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 (PHI) used for the purpose of treatment, payment, and health care operations. 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. The Notice, given with this Agreement, explains HIPAA and its application to your personal health information in greater detail. The law requires that I obtain your signature acknowledging that I have provided you with this information. Although these documents are long and sometimes complex, it is very important that you read them carefully before our next session. We can discuss any questions you have about the proce
Agreement for Psychological ServicesAgreement for Psychological Services • June 15th, 2021
Welcome to my practice. This contract contains important information about my professional services and business policies. Please read it carefully and ask questions you might have so that we can discuss them. Once you sign this contract, it will establish an agreement between us.
Psychological Solutions, LLC Agreement for Psychological ServicesAgreement for Psychological Services • December 16th, 2008
Welcome to our practice. This document (the Agreement) contains important information about Psychological Solutions, LLC professional services and business policies.
