KIDSTON HOUSEPsychotherapist-Client Agreement • August 1st, 2016
Renée Flam, LCSW, ACSWPsychotherapist-Client Agreement • October 16th, 2021
SPAULDING PSYCHOLOGICAL SERVICES, PLLC (SPS)Psychotherapist-Client Agreement • May 3rd, 2017
This agreement contains information about my professional services, business policies and the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is a federal law that provides privacy protections and patient rights about the use and disclosure of your protected health information (PHI) used for the purpose of treatment, payment and health plan obligations. HIPAA requires that I provide you with a Notification of Privacy Practices (Notice) and that I obtain your signature to acknowledge that I have provided this information to you. After you read this agreement we can discuss, how these issues apply to your own situation, and I will ask you to sign it at the end and I will sign it as well. When you sign this document, it will represent an agreement between us. You may revoke this agreement in writing at any time. That revocation will be binding on me unless I have acted in reliance on it; if there are obligations imposed on me by your health insurer to process or substan
Jessica Carlin LCSW 1804 NE 45th Ave Portland, OR 97213Psychotherapist-Client Agreement • August 29th, 2020
