REGISTRATION AND PSYCHOTHERAPIST-PATIENT SERVICES AGREEMENTRegistration and Psychotherapist-Patient Services Agreement • October 29th, 2021
Welcome to the Wisconsin School of Professional Psychology (WSPP) Psychology Center. This agreement contains important information about the Center’s services and about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights. HIPAA requires that I provide you with a Notice of Privacy Practices for use and disclosure of Protected Health Information (PHI). Please read these documents carefully. If you have any questions about them or about your rights, you can discuss them with me, with my supervisor, or with the Director of the WSPP Psychology Center. You may file a grievance if you feel that you have been treated unfairly. When you sign this document, it will also represent an agreement between us. You may revoke this Agreement in writing at any time. That revocation will be binding on me unless (a) I have already taken action on it, (b) there are health insurance claims already in progress, or (c) you have not
