Enrich Relationship Center of ColoradoTMTherapist-Client Services Agreement • May 29th, 2022
Welcome to Enrich Relationship Center of Colorado, formerly Sauder Psychology, Inc. This document (the Agreement) contains important information about 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) for the purposes of treatment, payment, and health care operations. HIPAA requires that we provide you with a Notice of Privacy Practices (the Notice) for the 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 your signature acknowledging that you have been provided with this information. Although these documents are long and sometimes complex, it is very importan
Therapist-Client Services AgreementTherapist-Client Services Agreement • October 25th, 2021
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 new federal law that provides new privacy protections and newpatient rights with regard to the use and disclosureof your Protected Health Information (PHI) used for the purposes of treatment, payment and health care operations. HIPAA requires that I provide you with a Notice of Privacy Practices (the Notice) that I provide for use and disclosure PHI for treatment, payment and healthcare 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 caref
THERAPIST-CLIENT SERVICES AGREEMENTTherapist-Client Services Agreement • November 4th, 2020
Nashville Emotional Wellness (NEW) Counseling specializes in providing therapeutic and practical counseling that utilizes systems, tools, strategies and techniques that increase your ability to be your best self. Unlike any other area in life, therapy provides individuals with a relationship that is totally focused on them. Nashville Emotional Wellness (NEW) Counseling builds on this relationship dynamic by meeting you where you are to support you in identifying and standing in your truth. Through focused work on self compassion, acceptance, forgiveness and gratitude, Nashville Emotional Wellness (NEW) Counseling aids in nurturing a sense of emotional safety that allows for the releasing of blockages and the healing of wounds.
THERAPIST-CLIENT SERVICES AGREEMENTTherapist-Client Services Agreement • August 20th, 2021
This Agreement is intended to provide (herein "Client") with important information regarding the practices, policies and procedures of Kelley Butler, LCSSW #19697 (herein "Therapist"), and to clarify the terms of the professional therapeutic relationship between Therapist, Client, and the Financial Sponsor. Any questions or concerns regarding the contents of this Agreement should be discussed with Therapist prior to signing. This agreement also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a 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 HI
THERAPIST-CLIENT SERVICES AGREEMENTTherapist-Client Services Agreement • October 13th, 2013
Welcome to Latitude Therapeutic Practices, LLC. This Agreement contains important information about 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 you are provided with a Notice of Privacy Practices (the Notice) for use and disclosure of PHI. The Notice, which is attached to this Agreement, explains HIPAA and its application to your PHI in greater detail. The law requires that your signature is obtained to acknowledge that this information has been provided to you. Although these documents are long and sometimes complex, it is important that you read them carefully. Feel free to discuss any questions you have about the procedures. When you sign th
Serenity Solutions, LLCTherapist-Client Services Agreement • April 28th, 2016
During your first few sessions, your therapist will be gathering information about your background and the problems and symptoms you are experiencing in order to evaluate your needs. By the end of this assessment period we may be able to give you some impression of what your work will include and what goals you will be attempting to accomplish during your therapy. Therapy is shaped by your personality, the training and characteristics of your therapist, and the particular problems you are experiencing. Unlike most visits to a doctor or medical specialist, therapy involves an active partnership between you and your therapist.
Enrich Relationship Center of ColoradoTMTherapist-Client Services Agreement • September 12th, 2021
Welcome to Enrich Relationship Center of Colorado, formerly Sauder Psychology, Inc. This document (the Agreement) contains important information about 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) for the purposes of treatment, payment, and health care operations. HIPAA requires that we provide you with a Notice of Privacy Practices (the Notice) for the 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 your signature acknowledging that you have been provided with this information. Although these documents are long and sometimes complex, it is very important
Therapist-Client Services AgreementTherapist-Client Services Agreement • April 5th, 2021
Welcome to Pitts & Associates. 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 patient rights with regards to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operations.
THERAPIST-CLIENT SERVICES AGREEMENT CHARLES A. SCHAEFER, PH.D., INC.Therapist-Client Services Agreement • January 1st, 2013
policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law designed to protect your privacy and your 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 the attached Notice of Privacy Practices that explains HIPAA and how it affects you. The law also requires that we obtain your signature acknowledging that you have received this information. Although these documents are long and sometimes complex, it is very important that you read them carefully. We can address any questions you have about the procedures before your next session. When you
THERAPIST-CLIENT SERVICES AGREEMENT CATHERINE M. LESLIE, PH.D., PLLCTherapist-Client Services Agreement • September 11th, 2010
