Counselor-Client Services AgreementCounselor-Client Services Agreement • November 18th, 2020
This document outlines my policies and guidelines and also contains important information about the Health Insurance Portability and Accountability Act or HIPAA. This is a federal law that provides privacy protections and client rights regarding the use and disclosure of your Protected Health Information. This information is collected and used for the purpose of treatment, payment, and health care practices.
Counselor-Client Services AgreementCounselor-Client Services Agreement • October 11th, 2016
Welcome to my practice! This document contains important information about my services and policies. Please review all the following information carefully as it will represent an agreement between us. You may revoke this agreement in writing at any time. That revocation will be binding on us unless I have taken action in reliance on it, such as: (1) if there are obligations imposed on me by your health insurer in order to process claims made under your policy, or (2) if you have not satisfied any financial obligation you have incurred within 30 days of receiving balance notification.
COUNSELOR - CLIENT SERVICES AGREEMENTCounselor - Client Services Agreement • October 21st, 2015
**Although this document is long and sometimes complex, it is very important that you read it carefully before your next appointment**
COUNSELOR - CLIENT SERVICES AGREEMENTCounselor - Client Services Agreement • August 11th, 2010
My signature below indicates that I have received and had the opportunity to read and discuss the Counselor- Client Services Agreement. I understand and agree to its terms and I willingly grant permission for me or my child to be treated by RHEMA Counseling & Support Services, PC.
ContractCounselor-Client Services Agreement • January 2nd, 2014
COUNSELOR-CLIENT SERVICES AGREEMENTCounselor-Client Services Agreement • October 12th, 2021
This form has been developed to provide you with information about counseling procedures and practices. It contains information about the Health Insurance Portability and Accountability Act (HIPPA) Privacy rule, and some professional ethical codes relevant to therapy. You may choose to revoke this agreement at any time, which will mean you no longer consent to treatment, however, some parts may still be enforced.
