Kari Berquist, Ph.D., BCBA-DInformed Consent Client Services Agreement • October 8th, 2024
Welcome to my practice! This document contains important information about my professional services and business policies. Please be sure to read the following information very carefully in order to prevent any misunderstandings. Please feel free to ask any questions. After you sign this document, it represents an agreement between us.
Kathi Bjerg, RD, LDInformed Consent & Client Services Agreement • February 12th, 2022
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 for 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 healthcare 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 healthcare 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 you read them carefully be
