Psychotherapy Service AgreementPsychotherapy Service Agreement • February 26th, 2023
Reduced fees may be negotiated in cases of need. Clients are expected to pay at the time of service by check, credit card or cash.
Psychotherapy Service AgreementPsychotherapy Service Agreement • February 26th, 2023
Reduced fees may be negotiated in cases of need. Clients are expected to pay at the time of service by check, credit card or cash.
PSYCHOTHERAPY SERVICE AGREEMENT FOR THE TREATMENT OF ADULT CLIENTSPsychotherapy Service Agreement • November 5th, 2020
Welcome to my practice. This document contains important information about my professional services and business policies and information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law providing privacy protections and client rights regarding 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 offer you with a Notice of Privacy Practices for use and disclosure of PHI for treatment, payment, and health care operations. This explains HIPAA and its application to your PHI. The law requires that I obtain your signature acknowledging that I have provided you this information by the end of this session. Please read them before our next session. We can discuss any questions you have at that time. When you sign, it will represent an agreement between us, which you may revoke at any time. That revocation will be binding on me unless I have taken actio
PSYCHOTHERAPY SERVICE AGREEMENT FOR THE TREATMENT OF CHILD & ADOLESCENT CLIENTSPsychotherapy Service Agreement • September 23rd, 2020
Welcome to my practice. This document contains important information about my professional services and business policies. It also contains information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law providing privacy protections and client rights regarding 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 offer you with a Notice of Privacy Practices for use and disclosure of PHI for treatment, payment and health care operations. This explains HIPAA and its application to your personal health information. The law requires that I obtain your signature acknowledging that I have provided you this information by the end of this session. It is very important that you read them carefully before our next session. We can discuss any questions you have at that time. When you sign this, it will also represent an agreement between us. You may revoke th
PSYCHOTHERAPY SERVICE AGREEMENT FOR THE TREATMENT OF CHILD & ADOLESCENT CLIENTSPsychotherapy Service Agreement • December 9th, 2020
Welcome to my practice. This document contains important information about my professional services and business policies. It 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.
Sherri H. Rawsthorn, LCSW, P.C.Psychotherapy Service Agreement • January 17th, 2018
Psychotherapy provides an opportunity for exploration, insight, healing, growth, and change. An optimal psychotherapy experience is grounded in the relationship that is established between the therapist and client. It is important that the conditions of this relationship are clearly outlined in order to create a consistent, stable, trusting, and safe working environment. The terms outlined below are intended to help ensure an optimal therapeutic relationship.
PSYCHOTHERAPY SERVICE AGREEMENTPsychotherapy Service Agreement • January 12th, 2024
Welcome to my practice. I hope your experience in therapy is positive and useful. I strongly be- lieve in the therapeutic benefits of personal exploration and healing. This document contains im- portant 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.
