PSYCHOTHERAPIST-CLIENT SERVICES AGREEMENTPsychotherapist-Client Services Agreement • October 28th, 2023
This agreement contains important information about the professional services and business policies at Behavioral Wellness Center of South Florida, LLC.
PSYCHOTHERAPIST-CLIENT SERVICES AGREEMENTPsychotherapist-Client Services Agreement • November 27th, 2023
Welcome to my practice. This document (the 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 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 I provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of PHI for treatment, payment and health care operations. The Notice, which is available on our website or in the waiting areas of our office, 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 i
PSYCHOTHERAPIST-CLIENT SERVICES AGREEMENTPsychotherapist-Client Services Agreement • April 13th, 2023
Welcome to this practice. This document (the Agreement) contains important information about our 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 Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operations. HIPAA requires that we provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of PHI for treatment, payment and health care 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 we obtain your signature acknowledging that we 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
PSYCHOTHERAPIST-CLIENT SERVICES AGREEMENTPsychotherapist-Client Services Agreement • July 5th, 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 client rights with regard to the use and disclosure of your Protected Health Information (PHI). HIPAA requires that I provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of PHI for treatment, payment and health care operations. The law requires that I obtain your signature acknowledging that I have provided you with this information. Although these documents are long and sometimes complex, it is very important that you read them carefully before our next session. We can discuss any questions you have about the procedures at that time. When you sign this document, it will also represent an agreement between us. You may revoke this Agreement in writing at any time. That revocati
Psychotherapist-Client Services AgreementPsychotherapist-Client Services Agreement • July 27th, 2020
Welcome to my office and practice. This document (the Agreement) contains important information about my professional services and business policies, all of which conform not only to the Health Insurance Portability and Accountability Act (HIPAA), but also to the laws of the State of Georgia. It also contains summary information about HIPAA, a new federal law that provides new privacy protections and new 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 also provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of PHI for treatment, payment and health care 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, as your individual psychotherapist, have provided
PSYCHOTHERAPIST-CLIENT SERVICES AGREEMENTPsychotherapist-Client Services Agreement • March 19th, 2020
Welcome to the Central DuPage Pastoral Counseling Center. This document contains important information about our professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a new federal law that provides new privacy protections and new 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 we provide you with a Notice of Privacy Practices for use and disclosure of PHI for treatment, payment and health care 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 we obtain your signature acknowledging that I have provided you with this information at the first session. Although these documents are long and sometimes complex, it is very important that
PSYCHOTHERAPIST-CLIENT SERVICES AGREEMENTPsychotherapist-Client Services Agreement • March 25th, 2019
Welcome to my practice. This document (the Agreement) contains important information about my professional services and business policies. Although the Agreement is long and sometimes complex, please read it carefully before signing and bring up with me any questions you may have. You may revoke this Agreement in writing at any time.
PSYCHOTHERAPIST-CLIENT SERVICES AGREEMENTPsychotherapist-Client Services Agreement • March 18th, 2015
Everything discussed in session is confidential. I will disclose information about your treatment to others only with your written authorizations. The only exceptions to this are suspected abuse or neglect of a child or an elderly person, the expressed intention to harm yourself or someone else, or an order by a judge. Confidentiality and the above exceptions are determined by federal and state laws and by the ethical practices outlined by the professional licensing board.
Psychotherapist-Client Services AgreementPsychotherapist-Client Services Agreement • January 2nd, 2019
Welcome to my practice. This document contains essential information about my professional services and business policies.
Psychotherapist-Client Services AgreementPsychotherapist-Client Services Agreement • April 17th, 2020
This form has three purposes. First, it tells you about my procedures and policies concerning important aspects of your psychotherapy. Please let me know if you have concerns about any of these policies. Your first visit will help me get a general understanding of your situation in order to determine how I might best help you. Because I want you to participate actively in planning your counseling, don’t hesitate to ask questions.
PSYCHOTHERAPIST-CLIENT SERVICES AGREEMENTPsychotherapist-Client Services Agreement • October 2nd, 2012
Everything discussed in session is confidential. I will disclose information about your treatment to others only with your written authorizations. The only exceptions to this are suspected abuse or neglect of a child or an elderly person, the expressed intention to harm yourself or someone else, or an order by a judge. Confidentiality and the above exceptions are determined by federal and state laws and by the ethical practices outlined by the professional licensing board.
PSYCHOTHERAPIST–CLIENT SERVICES AGREEMENTPsychotherapist–client Services Agreement • December 23rd, 2010
Welcome to my practice. This document (the Agreement) contains important information about my professional services and business politics. It also contains information about the Health Insurance Portability and Accountability Act (HIPAA), a new federal law that provides new privacy protections and new 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 (the Notice) for use and disclosure of PHI for treatment, payment and health care 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. Although these documents are long and sometimes complex, it is very important that you read them carefully before our ne
