Thank you for your purchase of the Common Private Practice Forms Package. Whether you’ve chosen paper charting or an EHR, you need Samples to review in order to develop your specific practice forms. The forms in this package will help get you started.
Other forms needed, such as HIPAA Notice of Privacy Practices, HIPAA Notice of Privacy Practices Acknowledgement of Receipt, Informed Consent for Telehealth, and Informed Consent for Social Media Policy, can be found online.
This packet contains 15 SAMPLE editable forms in .docx format. With minor editing, these forms can be ready for printing. Change “(clinician) address phone” sections to your information and adjust to fit on the page after your line edits are complete.
These forms have been created specifically to help you develop your private practice forms for use on paper, but the information can be adapted for EHR use.
These forms have not been reviewed for legal purposes. By using these forms or an edited version, you agree to do your own research in regard to private practice documentation requirements. Take these forms to your risk management attorney and liability insurance carrier for review. The following forms are included:
- Registration Form
- Diagnostic Assessment / Biopsychosocial Evaluation
- Client Payments Form for Chart
- Informed Consent for Psychotherapy
- Introductory Letter
- Practice Policies
- Confidential Psychotherapy Notes
- Receipt for Payment / Superbill
- Sliding Scale Payment Agreement
- Treatment Plan
- Sublet Rental Agreement
- Group Therapy Note
- Group Therapy Informed Consent
- Progress Note with Treatment Plan
- Blank Sample CMS1500 (not usable)
For questions or comments
908 Taylorville Rd #105
Grass Valley, CA 95949