Thanks for purchasing my Practice Forms Packet!
Below you will find the links to the forms that are part of this Packet. Click on a link, download the form, and customize any form with your practice information. Please contact us at firstname.lastname@example.org if you have difficulty downloading any of these forms.
- Sample Notice of Good Faith Estimate, 1.3.22 (to comply with the No Surprises Act, Jan 2022)
- Sample Good Faith Estimate 1.3.22 (to comply with No Surprises Act, Jan 2022)
- Telehealth Informed Consent (to give to clients)
- Telehealth Policies and Procedures 10.2021 (internal document insurance plans may want you to have)
- Credit card authorization 2021
- New Client Registration Form
- Treatment Agreement [aka Informed Consent] for Adults
- Sample Treatment Agreement [aka Informed Consent] for Minors
- Sample Treatment Agreement [aka Informed Consent] for Couples
- Invoice/Statement/Superbill with Common CPT codes
- HIPAA Notice of Privacy Practices
- Release of Information
- Session and Payment Record (Tracks Sessions and Payments)
- Fax Cover Page
- GRISWOLD Progress note template (updated for telehealth)
- SOAP PROGRESS NOTE TEMPLATE (updated for telehealth)
- DAP PROGRESS NOTE TEMPLATE (updated for telehealth)
- Private Pay Agreement (for insurance clients waiving use of insurance, or wanting to pay out of pocket for non-covered services like extended sessions, or for private-pay clients attesting they don’t have coverage)
- Checking Coverage 12 Essential Questions (Updated for telehealth)
- Coordination of care with other treating providers form 10.2021
Disclaimer: While these forms are designed to meet common insurance plan expectations plus federal and state laws, each state and insurance plan has different requirements. These sample forms are not meant to take the place of legal consultation regarding what should be in your medical records. It is always recommended that the healthcare provider check with a client’s insurance plan to find out specific documentation expectations, and investigate state and federal laws that may apply to their situation.