Common Contracts
1 similar Patient Services Agreement contracts
Diana Mansfield, LMHC, RYT - Still Waters WellnessPatient Services Agreement • November 21st, 2023
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 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. The law requires that I obtain your signature acknowledging that I have provided you with this information at the end of this session. Although this document is long and sometimes complex, it is very important that you read it carefully before our next session. We can discuss any questions you have about the procedures at that time.
