Psychologist – Client Agreement Sample Contracts

Dr. Eileen R. Borris
Psychologist-Client Agreement • April 16th, 2020

Welcome to my practice! This document (the “Agreement”) contains important information about my professional services and policies. It is intended to help clients understand how my practice operates with respect to the psychologist-client relationship. Please read this information and ask me any questions you may have. Your signature on this document will represent an Agreement between us. You may revoke this Agreement in writing at any time, and that revocation will be binding unless: a) I have taken action in reliance on it; b) your health insurer imposes obligations on me in order to process or substantiate claims made under your policy; or c) you fail to satisfy any financial obligations you have incurred.

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PSYCHOLOGIST – CLIENT AGREEMENT (CLIENT COPY)
Psychologist – Client Agreement • May 5th, 2016

Kinexus psychology is committed to ensuring that personal information collected is dealt with in accordance with the Information Privacy Principles contained in the Information Privacy Act 2009.

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