PSYCHOLOGIST-CLIENT SERVICE AGREEMENTPsychologist-Client Service Agreement • December 31st, 2020
Welcome to my practice. 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 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 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 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 is very important that you read them carefully before our next session. We can discuss any
PSYCHOLOGIST-CLIENT SERVICE AGREEMENTPsychologist-Client Service Agreement • October 26th, 2017
Welcome to my practice. This document contains important information about my professional services and business policies.When you sign this document, it will also represent an agreement between us. We can discuss any questions you have when you sign them or at any time in the future.
PSYCHOLOGIST-CLIENT SERVICE AGREEMENTPsychologist-Client Service Agreement • July 21st, 2016
Welcome to my practice. I appreciate the opportunity to work with you. 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 federal law that provides privacy protections and patient rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. Although these documents are long and sometimes complex, it is very important that you understand them. When you sign this document, it will also represent an agreement between us. We can discuss any questions you have when you sign them or at any time in the future.
PSYCHOLOGIST-CLIENT SERVICE AGREEMENTPsychologist-Client Service Agreement • October 14th, 2016
Welcome to my practice. 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 federal law that provides privacy protections and patient rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. Although these documents are long and sometimes complex, it is very important that you understand them. When you sign this document, it will also represent an agreement between us. We can discuss any questions you have when you sign them or at any time in the future.
PSYCHOLOGIST-CLIENT SERVICE AGREEMENT FOR PSYCHOLOGICAL TESTINGPsychologist-Client Service Agreement • February 2nd, 2021
This Informed Consent form is designed to explain the policies and procedures for an evaluation or psychological services with Dr. Virginia Lindahl. There is a separate consent form for cognitive testing as part of the independent schools’ admissions process and for therapy services. Please thoroughly review this document as it contains information that is very important for you to know.
PSYCHOLOGIST-CLIENT SERVICE AGREEMENTPsychologist-Client Service Agreement • January 2nd, 2021
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 federal law that provides privacy protections and patient rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. Although these documents are long and sometimes complex, it is very important that you understand them. When you sign this document, it will also represent an agreement between us. We can discuss any questions you have when you sign them or at any time in the future.
