This amazing Practice Forms Packet includes 22 essential forms, including a Good Faith Estimate Notification and Sample Good Faith Estimate Template (required as of 1/1/2022 to give to all self-pay clients by the No Surprise Act — read more here). Also Treatment Agreements for Couples, Individuals, and Minors,Plus Telehealth Consent, Credit Card Authorization updated for telehealth. It also includes a Coordination of Care Form (a frequent insurance requirement), to allow you to send info to a client’s doctor or other treating providers, sample progress notes templates, and other essential forms. The packet was put together by an insurance expert with an eye toward meeting common legal and ethical requirements as well as insurance plan expectations. These forms are terrific if you’re just setting up your practice, or never spent much time on your forms, or if you are now needing new forms to meet new legal requirements or for your video and phone sessions and credit card charges.
The forms will be sent to you in digital format (Word documents) so you can easily customize them for your practice. And they are so affordable, at less than $4.5o each!
The packet of forms includes:
- Good Faith Estimate Template (required to give to all self-pay clients as of 1/1/22 by the No Surprises Act)
- Good Faith Estimate Notification (required to give this on a separate form for all self-pay clients as of 1/1/22)
- Telehealth Informed Consent (for Clients)
- Telehealth Policies and Procedures (Internal Document Required by Some Insurance Plans)
- Credit Card Authorization (updated for telehealth)
- New Client Registration/Data Form
- Treatment Agreement for Adults
- Couples Treatment Agreement (including Secrets Policy and Records Release info)
- Treatment Agreement for Minors
- Sample Invoice/Statement/Superbill with common CPT codes
- Notice of Privacy Policies (HIPAA)
- Release of Information
- Session/Payment Record (Tracks Sessions and Payments)
- Fax Cover Sheet
- SOAP Progress Notes Template
- DAP Progress Notes Template
- GRISWOLD Progress Notes Template
- Checking Insurance Coverage: 13 Questions to Ask (updated for telehealth)
- Out-of-Network Checking Coverage Form (to give clients, or to check out-of-network coverage)
- Private Pay Agreement (for insurance clients wanting to pay out of pocket for non-covered services like extended sessions, or wanting to waive using their insurance, or for private-pay clients attesting they don’t have coverage)
- Coordination of Care with Doctor/Other Treating Provider Form
- Brief Mental Status Exam
Not available individually. To purchase, click on “Add to Cart” above.
After your purchase, wait! You should be automatically redirected to a “Thank You” page with a list of your purchases and all the downloadable items. We will also follow up via email within one business day with a link to the forms. If you do not receive the follow up email please check your spam folder. If after one business day you have not received the follow up email, and they are not in your spam folder, please contact us at firstname.lastname@example.org.
Disclaimer: Forms in this packet are meant to be a guide only. State laws, ethics codes, federal regulations, and insurance plan requirements may vary widely between professions, states and plans, and practice policies may vary widely between practitioners.