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bullet Fact Sheets
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

bullet Forms
Responsibility Release (Client Self-Discharge) — This form can be used when a client chooses to terminate treatment against the advice of the therapist. (0720)

Parental Consent for Treatment of Minors — This form can be used when working with children and teens in individual treatment. It is recommended that clinicians meet with the parents/guardians, and then with the children or teens, as appropriate to their developmental level. This will assist discussions with the child regarding confidentiality, information sharing, and records access. (0720)

Request for Restriction on Use/Disclosure of Protected Health Information — This form is used by clients to request restriction on use of protected health information. (0720)

Consent for Treatment Using Exposure Therapy — The purpose of this form is to request the client’s consent for exposure therapy treatment. (0720)

Request to Access Records — This form is used by clients to request copies of their own records. (0720)

Electronic Communication Policy — This form outlines the policy for electronic communication to ensure the security and confidentiality of treatment and to make sure it is consistent with ethics and laws. (0720)

Excuse Note for School — This letter template can be used if a child or adolescent needs an excuse for school to attend counseling appointments. (0720)

Guest Therapy Consent — The purpose of this form is to allow a guest to participate in a therapy session as a third-party participant. (0720)

Client Referral Letter to Physician — This letter can be used when referring a client to another professional. (0720)

Child and Adolescent Counseling Agreement — This form is designed to be given to older children and adolescents at the beginning of counseling to orient them to the basic purposes of therapy. (0720)

Permission to Obtain or Release Confidential Information — This form can be used to obtain or release confidential information.

Drug Testing Consent Form — This form can be used to obtain consent for drug testing. The form should be modified to fit the needs of the individual therapist or clinic.

Permission to Send Mail To Clients — This form can be used to get permission from your clients to mail them at their home address. Receiving mail can be a confidentiality concern for many clients.

Authorization to Release Confidential Information to Professionals — This form can be used by clinicians to obtain consent to release confidential information to other professionals. (0720)

Appointment Policy — This form outlines your clinic's appointment policy.

bullet Worksheets
Professional Will — This form helps professionals plan for how their practice will be handled in the event of their death or inability to continue as a professional. It is designed to be a template for a professional to think about how others might handle patient records, passwords, patient referrals, and more. (0421, liability, practice management)

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