INFORMED CONSENT AND SERVICE AGREEMENTInformed Consent and Service Agreement • March 22nd, 2009
This document contains important information about my professional services and business policies. Please read it carefully and jot down any questions you might have so that we can discuss them at our next meeting. When you sign this document, it will represent an agreement between us.
INFORMED CONSENT AND SERVICE AGREEMENTInformed Consent and Service Agreement • August 15th, 2019
Welcome to Safe Connections. This document contains important information about your rights, our services and guidelines. A copy of this document will be provided to you at the end of your appointment.
INFORMED CONSENT AND SERVICE AGREEMENTInformed Consent and Service Agreement • February 28th, 2021
Therapy is a relationship that works in part because of clearly defined rights and responsibilities held by each person. This frame helps to create the safety to take risks and the support to become
INFORMED CONSENT AND SERVICE AGREEMENTInformed Consent and Service Agreement • March 21st, 2008
This document 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 new patient rights with regard to the use and disclosure of your Protected Health Information used for the purpose of treatment, payment, and health care operations. HIPAA requires that I provide you with a Notice of Privacy Practices for use and disclosure of PHI for treatment, payment and health care operations. The Notice 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 the first session if possible. Although these documents are long and sometimes complex, it is very important that you read them carefully before our next session. I can discuss any questions you
