1. Assignments of Insurance Benefits for Therapy Sessions

   • This Insurance Billing Authorization Form is essential for any therapist who accepts either in-network or out-of-network insurance from their clients for services rendered.

   • There are two Assignment of Insurance Benefit Documents (one for Florida specifically and one for Multi-State)

2.  Biopsychosocial Intake and Client Information Forms (Child and Adult Forms)

   • The Biopsychosocial Intake Forms cover the necessary biological, psychological, and social assessment to be completed by clients or their parents/guardians before their first session.

   • It also collects the necessary client information and demographics for client records.

   • This includes two different thorough assessment forms, one for minors (child and adolescent) and the other for adults.

3. Biopsychosocial Intake and Client Information for Couples

   • This intake form is specifically designed for couples so that each partner can complete their intake form separately. This form has the necessary attributes of a regular intake form, but is focused on their relationship dynamics, history, potential for abuse, etc. 

4. Collection Letter for Past Due Therapy invoices

   • This financial collection letter is for therapists who accept insurance or cash payments for services rendered. If clients have a past-due balance, this form is the perfect template for therapists to send addressing the past-due balance and requesting payment. 

5. Consent, Policies & Agreement for Insurance and Self-Pay Practices

   • Limits to Confidentiality – including areas regarding electronic communication, social media, dual relationships & public interactions, court orders, legally issued subpoenas, couples counseling and “no secrets policy”, and fee/credit card disputes.

   • Therapeutic Process – including risks & benefits, expectations, structure and length of therapy, cancellation policy, fee structure including trial and litigation, copies of medical records, phone, and emergency policy.

   • Explanation of the Reasons for Not Accepting Insurance  – including risks, myths of confidentiality, and impacts of having a mental health disorder diagnosis.

   • Emergency Contact & Consent

   • Consent to Treat Minor and Adult Clients

6. Discharge/Therapy Termination Summary

   • This document is to be completed by the therapist upon discharge or termination of therapy services. This summary reviews the necessary information regarding the context of treatment termination such as dates, diagnoses, treatment participation, observations, risk factors, clinical recommendations, aftercare plan, support systems, etc…

7. Documentation/Communication Form for Counseling

   • This form provides a format for documenting any and all interactions with clients such as phone calls, scheduling changes, collaborations with other treatment providers (providing a release has been signed), and family/significant other communication (providing a release has been signed), etc.

8. Email Confidentiality Form Template for Therapy Practices

   • This email confidentiality template is attorney-approved and ready for use in your email signature ensuring recipients are aware of your privacy/confidentiality policies for electronic communications.

9. Good Faith Estimate

   • The “No Surprises Act” was implemented January 1, 2022.  It impacts private pay clinicians OR clients who chose NOT to use their insurance for therapy services.  Therapists now have to provide a Good Faith Estimate (GFE) to the client prior to services commencing. 

10. Group Counseling Consent Form

    • Do you practice group counseling or want to start?  This Attorney Approved Group Counseling Consent is perfect for your group practice needs. It addresses group confidentiality, limits of confidentiality, benefits of counseling, as well as a place where you can put in all the information about your specific group structure ie: length, frequency, costs, attendance requirements, dates, expectations, etc.  This form is to be used in conjunction with HIPAA.  If you are seeing clients 1:1 you also need to have them complete the Therapy Consent Policies and Agreements.

11. HIPAA Form for Therapy Practices

    • This document contains important information about federal law, the Health Insurance Portability and Accountability Act (HIPAA), 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.

12. Letter of Progress for Therapy

    • This document is a template for writing a progress letter for the client, their support system, other treatment providers, and/or organizations mandating treatment.

13. Media Consent Form for Therapy Client Data for Research and Training

    • If you plan to photograph, videotape, audiotape, or share client identifying information in any publications, research, trainings, supervision, etc., this form is vital! The Media Consent Form outlines how and where the clients' information would be used. It also requires authorization from clients for their information to be shared.

14. Mental Status Exam and Diagnosis Form

    • Our mental status exam is the psychological equivalent of a physical exam that describes the mental state and behaviors of the client. It includes both objective observations of the therapist and subjective descriptions given by the client.

    • These forms also include an area for diagnosis and clinical summary/narrative.

15. Therapy Process/Progress Note Template

    • This process/progress note template is formatted to document completed client session notes.

16. Psychological Evaluation & Testing Consent

    • Are you a psychologist who performs testing or provides letters for court or 3rd parties on behalf of your clients? This consent follows the APA Code of Ethics regarding psychological testing. The consent allows you to list all of the services you provide and addresses confidentiality, testing purposes, bases of testing, request for accommodations, payment structure, and release of records.  

17. Release of Information for Therapists

    • As therapists, we must have a signed release of information authorization completed by each client before the therapist can communicate/collaborate with anyone outside of the therapy room.

    • This release of information provides options for either bilateral or unilateral authorization once signed by the client for any person or organization they identify.

18. Sliding Scale Therapy Payment Agreement 

    • This agreement specifies the detailed arrangement regarding the reduction in rate for services rendered in order to meet the needs of clients who aren’t able to pay the full rate for services.

19. Substance Abuse Intake Assessment

    • This assessment provides a template for clinicians to easily utilize when exploring substance use history, the role of substance abuse in one’s life, and past solutions for managing substance use.

20. Suicide Risk Assessment & Client Treatment Compliance Agreement 

    • This assessment and compliance agreement is a useful way to ensure you are assessing and documenting safety and treatment compliance issues. This document addresses areas such as safety or treatment concerns, triggers, medical/mental health issues risk factors, protective factors and resources, support systems, intervention plans, etc. This agreement is intended to be collaboratively completed and signed by both clinician, support people/parent, and client.

21. Therapy Superbill Template

    • For therapists who accept out-of-network insurance in their practice, this superbill template is a vital resource.

    • It includes all of the necessary documentation for therapists to complete in order for insurance companies to provide reimbursement for services rendered according to the specific benefits for each specific insurance plan.

    • It also includes a handy CPT Code for common services provided in therapy practices.

22. Technology-Assisted Counseling Consent

    • Do you provide or want to provide phone therapy or video conference therapy? If so, this form is a must! This Technology Assisted Counseling consent form outlines the logistics by discussing: limitations, logistics, technological challenges, confidentiality/privacy, payment, emergencies, cancellation policy, and consent for telehealth counseling.

23. Therapy Treatment Plan Template

    • Our treatment plan includes an assessment of the client’s strengths and resources; presenting problem narrative and supporting symptoms; primary and secondary diagnosis and ICD 9/10 codes; and up to 3 goals, objectives, interventions, and target dates.

24. Counseling Client Welcome Letter

    • This template is one you can revise that welcomes clients to your practice and lets them know a little about what they can expect from you and your business. Once you add your information and add your logo, you’re good to go!

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***As a reminder, our paperwork cannot be distributed or shared with anyone else. It’s for individual use only.***