Special Offer for SLPs in Private Practice
It's Better to Be Safe Than Sorry
Get Your Lawyer-Reviewed, Customizable Private Practice Forms
Use These Digital, Lawyer-Reviewed, Customizable and Professional-Looking Private Practice Clinic Forms for SLPs in Private Practice
Announcing a NEW WAY to simplify, streamline and protect yourself and your private practice (without it costing a fortune!)
You'll get 30+ Customizable Forms
General Acknowledgement of Forms
HIPAA Notice (aka Notice of Privacy Practices)
Acknowledgement of Receiving HIPAA Privacy Notice
Intake / Case History Form (Pediatric)
Intake / Case History Form (Adult)
Attendance Agreement / Cancellation Policy
Consent For Services Form
Attendance and Record of Payment
Record of Contacts
Payment Policy and Fee Schedule
Record of Client Contact
Screening Permission Form
Communication Preference Form
Consent for Observation
Consent for Exchange, Obtain or Release of Information
Health Insurance Verification Form
Release of Photographs / Videos Form
CMS1500 Form (Medicare)
Credit Card Authorization Form
Acknowledgement and Assumption of Risk
How Did You Hear About Us?
Client Testimonial Permission Form
Physician Referral Form
Fax Cover Sheet
Telepractice Consent Form (New!)
Sample School Contract (New!)
Sample Employment Agreement (New!)
Sample Independent Contractor Agreement (New!)
Here's Everything You Get:
You'll Get Immediate Access to the Private Practice Clinic Forms AND You'll Also Get Additional Bonuses to Further Protect Your Private Practice and Get Organized!
Do You Like to Dot Your i's and Cross Your t's?
Having The Private Practice Clinic Forms Are a GREAT Way to Add Protection to Your Private Practice
There Are Other Ways to Protect Yourself Legally, Financially, Professional and Personally.
I Want to Make Sure You Know ALL Of The Ways To Reduce The Risks Associated With Starting a Business
It's YOUR Private Practice so Why Not Make It Fully Yours
The Clinic Forms come in MS Word FOrmat So Taht You Can Do the Following:
✅ Add Your Own Logo and Branding
✅ Add Your Practice Name/Address
✅ Change The Wording To Meet Your Practice Needs (ex. "clients" vs. "patients")
✅ MS Word Format Can Be Opened In Google Docs / Pages (Will Need to Adjust Formatting)
❌ No Independent Clinician Branding
Like To Have Your Ducks in a Row?
Want To Keep Track of Everything as You Grow?
It's time to GET ORGANIZED!
Ever wanted a master "to do list" with all of the things you should be doing on a daily, weekly, and monthly basis?
Well ... here it is!
Special Thanks To The Contributors
Emily Leavitt Creteau, Janelle Fenwick, Jesse Ginsberg, Kelley Jewart, and Shanell Latta
Check Out These Reviews
✅ 10 Beginner Forms (a $997 Value)
✅ 20 Advanced Forms (a $1997 Value)
✅ The Risk Minimizer (a $197 Value)
✅ Full Customization Ability (a $297 Value)
✅ The Organized Private Practictioner Bundle (a $197 Value>
A $5,179 Value - Yours for ONLY $347
Do You have a Covid-specific form?
The Independent Clinician, LLC | Copyright ©2020 | All Rights Reserved
Please Read and Understand:
While I am experienced in researching, deciphering, and writing about HIPAA rules and regulations—as well as the associated legalese—I am not a lawyer, nor do I have any HIPAA certifications. I am simply providing professional assistance through proven strategies and resourceful features. As such, we make no warranties and the contents of these forms shall not be construed as legal advice. If you have specific questions about HIPAA rules, regulations, and laws, feel free to ask them in the comments section of the Member Area—but be advised, I am recommending that you speak to a legal professional or certified compliance expert.
You do not have any rights to share, sell, distribute, republish, transmit in any form, or profit from these forms. You cannot claim any type of ownership. All rights are reserved by the author, Jena H. Castro-Casbon, MS CCC-SLP.
All information contained within these forms is strictly the views represented by the author, at the time of publication. Said author can and does reserve the right to add to, change, alter or update the thoughts and opinions stated herein. Every attempt has been made to accurately substantiate all information in these forms. However the author makes no warranty to nor does she take responsibility for any errors or exclusions that may be contained within. The author does not offer legal or financial advice and the contents of these forms must not be construed as such. It is recommended the customer contact the appropriate qualified professional for advice in these and any other areas should it be needed. It is the responsibility of the customer to know and adhere to any local or organization (ASHA, AOTA, APTA) laws regarding the conducting of business in this specialized field.
Users of these forms are advised to do their own due diligence when it comes to making business decisions and all information, products, services that have been provided should be independently verified by your own qualified professionals. By using these forms and reading information in the Member Area, you agree that myself and my company is not responsible for the success or failure of your business decisions relating to any information presented.
The author, Jena H. Castro-Casbon, MS CCC-SLP is fully excluded from any liability that may arise out of the use or misuse of any information contained within these forms or content on this site.