Fill and Sign the Independent Contractor Licensed Form

Independent Contractor Agreement Between Licensed Counselor and Therapist and Licensed Counselor and Therapist Practicing as a Solo Practitioner Agreement made on this the __________________ (date) , between ________________________ (Name of Therapist practicing as a solo practitioner) of ___________________________________________________________________ ____________ (street address, city, county, zip code) , referred to herein as Therapist and _________________________ (Name of Contractor Therapist) of _____________________________________________________________________ (street address, city, county, zip code) , referred to herein as Contractor . Whereas, Therapist is a Licensed Professional Clinical Counselor and Marriage and Family Therapist and desires to associate someone into her practice with similar qualifications as an independent contractor to perform the same type of counseling and therapy said Therapist performs; and Whereas, Contractor is a (describe qualifications) ______________________ _____________________________________________________________________ and is licensed by the State of ___________________ (name of state) to treat patients as a Counselor and Therapist; and Whereas, Contractor wishes to contract with Therapist to practice clinical counseling and marriage and family therapy as an independent contractor in accordance with the terms and conditions set forth in this Agreement; Now, therefore, for and in consideration of the mutual covenants contained in this agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Services to be Rendered by Contractor A. Contractor will provide clinical counseling and marriage and family therapy for such patients as from time to time may be assigned to him by the Therapist or who may come to the clinic of Therapist to be counseled by Contractor. Contractor agrees to devote a substantial amount of his time and attention to such practice duties, and to perform such administrative duties as from time to time may be assigned to him by Therapist. Therapist will handle all billing and collection services as deemed appropriate. Contractor further agrees to: 1. Perform the usual duties and responsibilities that are expected of a licensed clinical counselor and therapist in a practice like that of Therapist during normal business hours, at night and on weekends and holidays if called upon to do so. 2. Render any emergency services to patients as may be required. B. Contractor shall maintain his license to practice clinical counseling and marriage and family therapy in the State of ___________________ (name of state) throughout the term of this Agreement. 2. Terminable at Will The parties understand and agree that this Agreement can be terminated by the either party, with or without cause, and with or without notice, at any time. 3. Compensation A. As compensation for his services rendered pursuant to this Agreement, the Therapist agrees to pay Contractor pursuant to the provisions set forth below. (Describe payment schedule and amount) _____________________ _______________________________________________________________ _______________________________________________________________ . B. Contractor will provide and pay for his own professional malpractice insurance and maintain a minimum coverage of (describe coverage) _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ . 4. Independent Contractor Status Contractor is an independent contractor and is not an employee, servant, partner or joint venturer of Therapist. Therapist shall determine the services to be provided by Contractor , but Contractor shall determine the means by which he accomplishes the services in accordance with this Agreement. Therapist is not responsible for withholding, and shall not withhold or deduct from the commissions FICA or taxes of any kind, unless such withholding becomes legally required. Contractor is not entitled to receive the benefits which employees of Therapist and is not entitled to receive and shall not be entitled to workers compensation, unemployment compensation, medical insurance, life insurance, paid vacations, paid holidays, pension, profit sharing, or Social Security on account of his services to Therapist. It is further understood that Contractor is free to contract for similar services with other clinical counselors and therapists or organizations while under contract with Therapist. 5. Facilities Therapist shall furnish Contractor with a private office, secretarial help, and such other facilities, equipment and support services suitable to his position and adequate for the performance of his duties under this Agreement. 6. Records of Patients All records relating to patients treated by Contractor pursuant to this Agreement shall belong to and remain the property of Therapist . 7. Severability The invalidity of any portion of this Agreement will not and shall not be deemed to affect the validity of any other provision. If any provision of this Agreement is held to be invalid, the parties agree that the remaining provisions shall be deemed to be in full force and effect as if they had been executed by both parties subsequent to the expungement of the invalid provision. 8. No Waiver The failure of either party to this Agreement to insist upon the performance of any of the terms and conditions of this Agreement, or the waiver of any breach of any of the terms and conditions of this Agreement, shall not be construed as subsequently waiving any such terms and conditions, but the same shall continue and remain in full force and effect as if no such forbearance or waiver had occurred. 9. Governing Law This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of ______________. 10. Notices Any notice provided for or concerning this Agreement shall be in writing and shall be deemed sufficiently given when sent by certified or registered mail if sent to the respective address of each party as set forth at the beginning of this Agreement. 11 . Mandatory Arbitration Any dispute under this Agreement shall be required to be resolved by binding arbitration of the parties hereto. If the parties cannot agree on an arbitrator, each party shall select one arbitrator and both arbitrators shall then select a third. The third arbitrator so selected shall arbitrate said dispute. The arbitration shall be governed by the rules of the American Arbitration Association then in force and effect. 12. Entire Agreement This Agreement shall constitute the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement. 13. Modification of Agreement Any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if placed in writing and signed by each party or an authorized representative of each party. 14. Assignment of Rights The rights of each party under this Agreement are personal to that party and may not be assigned or transferred to any other person, firm, corporation, or other entity without the prior, express, and written consent of the other party. 15. Counterparts This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original, but all of which together shall constitute but one and the same instrument. 16. In this Agreement, any reference to a party includes that party's heirs, executors, administrators, successors and assigns, singular includes plural and masculine includes feminine. WITNESS our signatures as of the day and date first above stated. ________________________ _________________________ (P rinted Name of Therapist) (P rinted Name of Contractor) ________________________ _________________________ (Signature of Therapist ) (Signature of Contractor)