COUNSELOR-CLIENT SERVICE AGREEMENTCounselor-Client Service Agreement • February 4th, 2022
This document 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 about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. Although these documents are long and sometimes complex, it is very important that you understand them. When you sign this document, it will also represent an agreement between us. We can discuss any questions you have when you sign them or at any time in the future.
COUNSELOR – CLIENT SERVICE AGREEMENTCounselor-Client Service Agreement • October 15th, 2018
Welcome to my practice. This document contains important information about my professional services and business policies. We can discuss any questions you have when you sign this or at any time in the future.
Delivered2ChoicesCounselor/Client Service Agreement • February 5th, 2020
Transcend CounselingCounselor-Client Service Agreement • May 28th, 2021
Welcome to my practice. This document 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 about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. Although these documents are long and sometimes complex, it is very important that you understand them. When you sign this document, it will also represent an agreement between us. We can discuss any questions you have when you sign them or at any time in the future.
COUNSELOR-CLIENT SERVICE AGREEMENTCounselor-Client Service Agreement • April 1st, 2020
Welcome to my practice. This document 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 about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. Although these documents are long and sometimes complex, it is very important that you understand them. When you sign this document, it will also represent an agreement between us. We can discuss any questions you have at anytime; now during the agreement signing or in the future.
Counselor - Client Service AgreementCounselor - Client Service Agreement • May 8th, 2024
Lesley University, Cambridge, MA – Masters in Arts, Mental Health Counseling, 2004 Tufts University, Medford, MA – Bachelors in Arts, English, 1994
ContractCounselor-Client Service Agreement • September 8th, 2021
Welcome to my practice. 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 new federal law that provides new privacy protections and new 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 is attached to 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 at the end of this session. Although these documents are long and sometimes complex, it is very important that y
COUNSELOR-CLIENT SERVICE AGREEMENTCounselor-Client Service Agreement • January 29th, 2017
Welcome to Bound Together Counseling. This document 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 patient rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. Although these documents are long and sometimes complex, it is very important that you understand them. When you sign this document, it will also represent an agreement between us. We can discuss any questions you have when you sign them or at any time in the future.
COUNSELOR-CLIENT SERVICE AGREEMENTCounselor-Client Service Agreement • May 17th, 2022
Welcome to Transcend Counseling. This document contains important information about the 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 about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. Although these documents are long and sometimes complex, it is very important that you understand them. When you sign this document, it will represent an agreement between Transcend Counseling and yourself.
COUNSELOR-CLIENT SERVICE AGREEMENT /INFORMED CONSENT FOR TREATMENTCounselor-Client Service Agreement • April 14th, 2017
Welcome to my practice. This document 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 client rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. Although these documents are long and sometimes complex, it is very important that you understand them. When you sign this document, it will also represent an agreement between us. We can discuss any questions you have when you sign them or at any time in the future.
Georg Associates www.GeorgAssociates.com LolaGeorgLPC@gmail.comCounselor - Client Service Agreement • October 18th, 2019
Welcome to Georg Associates, and Lola Georg, Licensed Professional Counselor. This document contains important informaHon about my professional services and business policies. It also contains summary informaHon about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protecHons and paHent rights about the use and disclosure of your Protected Health InformaHon (PHI) for the purposes of treatment, payment, and health care operaHons. Although these documents are long and someHmes complex, it is very important that you understand them. When you sign this document, it will also represent an agreement between us. We can discuss any quesHons you have when you sign them or at any Hme in the future.
