Therapist-Client Outpatient Services Contract Sample Contracts
THERAPIST-CLIENT OUTPATIENT SERVICES CONTRACTTherapist-Client Outpatient Services Contract • March 29th, 2011
Welcome to the office of Daniel Zimet, Ph.D. Please be advised that I am an indi- vidual practitioner and my counseling is not affiliated with any other agencies or mental health professionals. This document sum- marizes information about therapy, fees and billing, insurance, confidentiality, record keeping, and your rights as a client. It also contains summary information about the Health Insurance Portability and Accounta- bility Act (HIPAA), a federal law that pro- vides privacy protections and patient rights with regard to the use and disclosure of your Protected Health Information (PHI). 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 PHI in greater detail. The law requires that I obtain your signature acknowledging that I have provided you with this infor- mation by the end of your first session. When you sign the Cons