Psychological Services Agreement Sample Contracts

PSYCHOLOGICAL SERVICES AGREEMENT
Psychological Services Agreement • August 1st, 2023

This Agreement contains important information about my professional services and business policies. Please review it, note any questions you might have, and we will discuss them further during intake.

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AGREEMENT
Psychological Services Agreement • September 4th, 2007
AGREEMENT
Psychological Services Agreement • July 6th, 2006

This Agreement made this day of , 2006, by and between Dr. Bruce Cappo, Ph.D. of Clinical Associates, P.A., located at 8629 Bluejacket, Lenexa, Kansas 66214, hereinafter referred to as “Dr. Cappo,” and the City of Overland Park, Kansas, a municipal corporation and City in the first class, located at 8500 Antioch, Overland Park, Kansas, hereinafter referred to as “City.”

Psychological Services Agreement
Psychological Services Agreement • July 25th, 2018

The purpose of this document is to provide you with an outline of the services we have agreed upon, which is required prior to receiving the services of a Registered Psychologist.

PSYCHOLOGICAL SERVICES INDIVIDUAL & FAMILY GROUP PSYCHOLOGICAL COUNSELING
Psychological Services Agreement • November 18th, 2010 • Texas

This agreement is entered into by and between El Paso County, on behalf of the Juvenile Probation Department, hereinafter known as "JPD" and Reed & Associates, hereinafter known as "Contractor" to provide therapeutic services.

Psychological Services Agreement and Policies
Psychological Services Agreement • May 4th, 2014
AGREEMENT
Psychological Services Agreement • December 4th, 2009

This Agreement made this day of November 2009, by and between Bruce Michael Cappo, Ph.D. of Clinical Associates, P.A., located at 8629 Bluejacket Street, Suite 100, Lenexa, Kansas, hereinafter referred to as “Dr. Cappo,” and the City of Overland Park, Kansas, a municipal corporation, hereinafter referred to as "City," the City of Overland Park being a City in the first class, located at 8500 Santa Fe, Overland Park, Kansas 66212.

Psychological Solutions, LLC Agreement for Psychological Services
Psychological Services Agreement • March 14th, 2011

Welcome to our practice. This document (the Agreement) contains important information about Psychological Solutions, LLC professional services and business policies.

AGREEMENT
Psychological Services Agreement • September 4th, 2007

This Agreement made this day of , 2007, by and between Dr. Joi McNeley-Phelps, Ph.D. of Clinical Associates, P.A., located at 8629 Bluejacket, Lenexa, Kansas 66214, hereinafter referred to as “Dr. McNeley-Phelps,” and the City of Overland Park, Kansas, a municipal corporation and City in the first class, located at 8500 Santa Fe, Overland Park, Kansas, hereinafter referred to as “City.”

Michigan Neurodevelopment Center
Psychological Services Agreement • December 13th, 2021

Welcome to my practice. I appreciate your trust and the opportunity to help. Because all of us need to know we are in good hands, this document contains information about my practice and business policies. Please read it carefully and jot down any questions you have so that we can discuss them. When you sign this document, it will represent an agreement between us.

Psychological Services Agreement
Psychological Services Agreement • April 8th, 2020

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 Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operations.

Exhale Behavioral Health
Psychological Services Agreement • November 9th, 2018

This Agreement contains important information about the professional services and business policies. It is very important that you read this Agreement carefully and that you discuss any questions you may have. When you sign this document, it will also represent an agreement between us. You may revoke this agreement in writing at any time.

AGREEMENT FOR PSYCHOLOGICAL SERVICES
Psychological Services Agreement • May 2nd, 2012

This Agreement made this day of May 2012 by and between Clinical Associates, P.A., located at 8629 Bluejacket Street, Suite 100, Lenexa, Kansas, hereinafter referred to as "Clinical Associates," and the City of Overland Park, Kansas, a municipal corporation, hereinafter referred to as "City," the City of Overland Park being a City in the first class, located at 8500 Santa Fe, Overland Park, Kansas 66212.

AGREEMENT
Psychological Services Agreement • December 4th, 2009

This Agreement made this day of November 2009, by and between Joi McNeley-Phelps, Ph.D. of Clinical Associates, P.A., located at 8629 Bluejacket Street, Suite 100, Lenexa, Kansas, hereinafter referred to as “Dr. McNeley-Phelps,” and the City of Overland Park, Kansas, a municipal corporation, hereinafter referred to as "City," the City of Overland Park being a City in the first class, located at 8500 Santa Fe, Overland Park, Kansas 66212.

PSYCHOLOGICAL SERVICES
Psychological Services Agreement • February 28th, 2008 • Texas

This agreement is entered into by and between the El Paso County, on behalf of the Juvenile Probation Department, hereinafter known as "JPD" and J. Vincent Henneburg, d/b/a Henneburg Counseling, hereinafter known as "Contractor".

Agreement for Services Print Name: ____________________________________________________ ID #: ____________________
Psychological Services Agreement • June 5th, 2024

De Anza College Psychological Services provides brief counseling, crisis intervention, and mental health and substance abuse assessment. We also provide referrals to social support resources in the community.

SYLVIA M. DOSS, PH.D. AGREEMENT FOR PSYCHOLOGICAL SERVICES
Psychological Services Agreement • July 7th, 2022

Welcome to psychological services. I am a licensed Clinical Psychologist. I provide psychotherapy, marriage therapy, or rehabilitation counseling for individuals and couples. This agreement provides you with important information about my professional services and business policies.

PSYCHOLOGICAL SERVICES AGREEMENT & CONSENT for PSYCHOLOGICAL SERVICES
Psychological Services Agreement • May 5th, 2020

Welcome to the Psychological Services Center (PSC) at Bowling Green State University. This document contains important information about the PSC’s 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 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 the PSC provide you with a Notice of Privacy Practices for use and disclosure of PHI for treatment, payment and health care operations. The Notice, which must by law be given to you at your first session at the PSC, explains how the PSC complies with HIPAA in its maintenance and disclosure of your personal health information. The law requires that the PSC obtain your signature acknowledging that you have been provided with this information at the end of thi

Agreement for Services
Psychological Services Agreement • November 12th, 2019

De Anza College Psychological Services provides 10 sessions of brief counseling, crisis intervention, group counseling, and referrals to social support resources in the community. We are staffed by licensed Mental Health Professionals and supervised clinical psychology graduate interns.

Purchasing Division
Psychological Services Agreement • December 31st, 2014
Psychological Services Agreement and Policies
Psychological Services Agreement • April 30th, 2014
PSYCHOLOGICAL SERVICES AGREEMENT
Psychological Services Agreement • December 6th, 2020

Welcome to my practice! Please review and complete these forms and bring any questions to your first appointment. When you sign this document, it will represent an agreement between us.

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PSYCHOLOGICAL SERVICES AGREEMENT
Psychological Services Agreement • June 29th, 2018

This document contains important information about the professional services and business policies of Alison Jones, Ph.D., Licensed Clinical Psychologist. I am an independent practitioner and am not associated with or in business with any other practitioner in this location. Please read the information below carefully and feel free to discuss any questions you have.

Kendal Pritchard, CMHC
Psychological Services Agreement • March 7th, 2022

This document contains important information about the professional services and business policies of Kendal Pritchard, CMHC. Please read it carefully and note any questions you might have so we can discuss them. Your signature verifies this document as a legal and binding agreement between us.

FULL BATTERY PSYCHOLOGICAL SERVICES
Psychological Services Agreement • January 24th, 2008 • Texas

This agreement is entered into by and between the County of El Paso, on behalf of the Juvenile Probation Department, hereinafter known as "JPD" and Amanecer Psychological Services, hereinafter known as "Contractor".

Purchasing Division
Psychological Services Agreement • December 31st, 2014
Karen C. Fragetta, Ph.D., LLC
Psychological Services Agreement • August 9th, 2020

Welcome to my practice. I appreciate your trust and the opportunity to help. Because all of us need to know we are in good hands, this document contains information about my practice and business policies. Please read it carefully and jot down any questions you have so that we can discuss them. When you sign this document, it will represent an agreement between us.

INFORMATION AND AGREEMENT
Psychological Services Agreement • January 2nd, 2021

This document contains important information about the professional services and business policies of Kyle Max Hancock, PhD, PC. Please read it carefully and note any questions you might have so we can discuss them. Your signature verifies this document as a legal and binding agreement between us.

Purchasing Division
Psychological Services Agreement • December 31st, 2014
DISCLOSURE STATEMENT AND PSYCHOLOGICAL SERVICES AGREEMENT
Psychological Services Agreement • June 19th, 2017

This services 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 for use and disclosure of PHI for treatment, payment and health care operations.

PSYCHOLOGICAL SERVICES AGREEMENT
Psychological Services Agreement • November 23rd, 2020

This document contains important information about the professional services and business policies of David Shoup, Ph.D., Licensed Clinical Psychologist. I am an independent practitioner and am not associated with, or in business with, any other practitioner in this location. Please read the information below carefully and feel free to discuss any questions you have.

PSYCHOLOGICAL SERVICES AGREEMENT AND POLICIES
Psychological Services Agreement • August 9th, 2020
PSYCHOLOGICAL SERVICES AGREEMENT
Psychological Services Agreement • January 27th, 2022

This document contains important information about the professional services and business policies of David Shoup, Ph.D., Licensed Clinical Psychologist. I am an independent practitioner and am not associated with, or in business with, any other practitioner in this location. Please read the information below carefully and feel free to discuss any questions you have with me.

Atlanta Insomnia & Behavioral Health Services, P.C. Psychological Services Agreement
Psychological Services Agreement • January 9th, 2013

Welcome to our practice. This document contains important information about our professional services and business policies. Please read it carefully and be sure to let us know if you have any questions at the first session.

Kendal Pritchard, CMHC
Psychological Services Agreement • September 13th, 2021

This document contains important information about the professional services and business policies of Kendal Pritchard, CMHC. Please read it carefully and note any questions you might have so we can discuss them. Your signature verifies this document as a legal and binding agreement between us.

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