INFORMED CONSENT FOR THERAPY SERVICESInformed Consent for Therapy Services • December 19th, 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.
THERAPIST-CLIENT SERVICE AGREEMENTInformed Consent for Therapy Services • April 9th, 2022
Welcome to my practice. I am excited to work with you. This document contains important information about my professional services and business policies. We can discuss any questions you have when you sign this document, or at any time in the future.
INFORMED CONSENT FOR THERAPY SERVICES, TREATMENT AGREEMENT FOR MENTAL HEALTH SERVICES AND OFFICE POLICIESInformed Consent for Therapy Services • March 27th, 2020
Welcome to my practice! I’m glad you are here and want to do my best to serve you in a professional and courteous manner. This document contains important information about my professional services and business policies. Please read it carefully and let me know if you have any questions. When you sign this document, it will represent an agreement between us. If you decide that you do not wish to consent to these services and policies and, therefore, would not like to proceed with services here, there will be no charge for our meeting today.
PSYCHOLOGIST-CLIENT SERVICE AGREEMENTInformed Consent for Therapy Services • November 15th, 2017
Welcome to Pearl Vitality. This document contains important information about Pearl Vitality 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 (Client and Therapist). We can discuss any questions you have when you sign them or at any time in the future.
Dr. Pearl Zurich & AssociatesInformed Consent for Therapy Services • November 10th, 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 when you sign them or at any time in the future.
PSYCHOLOGIST-CLIENT SERVICES AGREEMENTInformed Consent for Therapy Services • August 18th, 2023
This document contains important information about my professional services and business policies. It also contains summary information about the Health Insurance Portability and
PSYCHOLOGIST-CLIENT SERVICE AGREEMENTInformed Consent for Therapy Services • June 5th, 2014
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.
PSYCHOLOGIST-CLIENT SERVICE AGREEMENTInformed Consent for Therapy Services • June 22nd, 2023
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.
PROVIDER – INDIVIDUAL SEEKING SERVICES AGREEMENTInformed Consent for Therapy Services • January 29th, 2012
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.
Informed Consent for Therapy Services THERAPIST-CLIENT SERVICE AGREEMENTInformed Consent for Therapy Services • October 26th, 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.
PSYCHOLOGIST-CLIENT SERVICE AGREEMENTInformed Consent for Therapy Services • February 13th, 2023
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.
CLIENT SERVICE AGREEMENTInformed Consent for Therapy Services • July 30th, 2019
Welcome to my practice. This document contains important information about my professional services and business policies. 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.
PSYCHOTHERAPIST-CLIENT SERVICE AGREEMENTInformed Consent for Therapy Services • January 10th, 2019
Welcome to Smithson Counseling. 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
Mary Clare MS Ed, MSW, LCSW-R 277 Alexander Street Suite 300 Rochester, New York 14607Informed Consent for Therapy Services • October 3rd, 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 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.
CLIENT SERVICE AGREEMENTInformed Consent for Therapy Services • January 14th, 2019
Welcome to Reflections Counseling Services. 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.
PSYCHOTHERAPIST-CLIENT SERVICE AGREEMENTInformed Consent for Therapy Services • May 4th, 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.
PSYCHOLOGIST-CLIENT SERVICE AGREEMENTInformed Consent for Therapy Services • January 2nd, 2021
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.
Dr. Richard Shook, Ph.D., LPC Johanna Wendell, M.A., LAPC 800 Kennesaw Avenue, Suite 320Informed Consent for Therapy Services • May 30th, 2014
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.
Intentional Connections PsychotherapyInformed Consent for Therapy Services • May 23rd, 2023
