INFORMED CONSENT AND SERVICES AGREEMENTInformed Consent and Services Agreement • February 25th, 2020
Take the time to read the following information. If you are unclear about any portion of, or have any questions about the information provided, please talk about it with Dr Takos.
INFORMED CONSENT AND SERVICES AGREEMENT - THERAPYInformed Consent and Services Agreement • October 26th, 2016
Welcome to my practice! 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. The Notice, which is a separate document, 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 also represent an agreement between us.
