• 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

• ​Payment Policy

• ​​Record of Contacts

• ​Payment Policy and Fee Schedule

• ​Record of Client Contact

• ​​Progress Report

• ​​​Progress Note

• Consent for Exchange, Obtain or Release of Information

• ​​​Health Insurance Verification Form

• ​​​Screening Permission Form

• ​Communication Preference Form

• ​​​Consent for Observation

• ​​​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

• ​​​​​Superbill (JUST ADDED!)

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.

LEGAL INFORMATION:

ALL RIGHTS RESERVED:

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.

DISCLAIMERS: 

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 the 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.

Liability:
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.