Clinician - Patient Service AgreementClinician - Patient Service Agreement • November 13th, 2024
This document contains important information about our professional services and business policies. It accompanies the information you were given about the Health Insurance Portability and Accountability Act (HIPAA). It is important that you read them carefully and understand them. We can discuss any questions you have. When you sign this document, it will represent an Agreement between us. You may revoke this Agreement in writing at any time. That revocation will be binding on Psychology Resources 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.
CLINICIAN – PATIENT SERVICE AGREEMENTClinician-Patient Service Agreement • October 23rd, 2020
Welcome to Insightful Direction! Please read the following information as it pertains to our professional and business standards. It is the utmost importance that you thoroughly read through the documents and if there are any questions or concerns you may have about the contents of this agreement, they can be discussed in the initial meeting with your clinician. Please note that once these documents are signed, we have a contractual agreement between us (you, the clinician, and Insightful Direction, LLC). You may at any time rescind this agreement in writing (two weeks notice prior if possible). Cancellation of our agreement is contingent upon if there are any outstanding financial obligations you have acquired with us.
