Financial

Between Sessions offers financial therapy forms that help keep you organized and on track with your practice. Download our counseling forms online and spend more time with your patients and less time managing the financial aspects of your practice. Check out other counseling form options on our website, including intake forms, office management forms, and more.

Principles of Ethical Payment & Billing for Therapist — This fact sheet describes general ethical guidelines for billing and payment for therapeutic services. It includes links to the specific guidelines of various professional organizations. PDF

Insurance Payer Appeals Letter (Timely Filing) — This letter can be used by therapists to appeal an insurance payer denial when a claim has been denied due to timely filing. (0720)

Ethical Payment Practices for Therapists — This document outlines ways therapists can adhere to sound ethical practices regarding fees. (0720)

Authorization for Recurring Credit Card Charges — This form can be used to obtain permission to keep a client’s credit card number on file and charge it as fees are incurred.

Invoice for Psychotherapy Services — This form can be given to clients to submit to their insurance companies for reimbursement.

Superbill — A Superbill is an itemized form used by healthcare providers to reflect rendered services. A Superbill is the main data source for creation of healthcare claim, which is submitted to payers to insurance companies or other payers.

Receipt For Therapeutic Services — This form can be given to a client as a receipt for services. There is one receipt for monthly services and one for individual sessions.

Sliding Scale Fee Agreement — This form can be modified to state a therapist’s sliding scale schedule and to obtain a signed agreement regarding the terms of a reduced fee.

Letter of Termination to Client for Nonpayment — This letter can be used as a template when a client must be terminated for nonpayment of agreed-upon fees.

Weekly Expense Log — This form can be used for therapists to keep track of their weekly expenses.

Payment Agreement for Past Services — This form can be used to document and have the client acknowledge fees owed for past services.

Financial Policy — This form is a model for financial policies to be reviewed and accepted by clients.