AGREEMENT FOR PSYCHOTHERAPY SERVICES/ INFORMED CONSENTAgreement for Psychotherapy Services/Informed Consent • September 6th, 2019
This document contains important information about our professional services and business policies. Although these documents are long and sometimes complex, it is very important that you read them carefully. When you sign this document, it will also represent an agreement between us and become a part of your electronic medical record. You may revoke this Agreement in writing at any time. That revocation will be binding on us (and our clinic) unless we have taken action in reliance on it; if there are obligations imposed on us by your health insurer in order to process or substantiate claims made under your policy; or if you have not satisfied any financial obligations you have incurred.
OFFICE POLICIES & GENERAL INFORMATIONAgreement for Psychotherapy Services / Informed Consent • March 29th, 2011
This form provides you (patient) with information that is additional to that detailed in the Notice of Privacy Practices.
