Is an electronic signature valid?

Yes. Electronic signatures are legally enforceable under the ESIGN Act (15 U.S.C. §7001) and UETA in most states when intent, consent, attribution, and record retention requirements are met.

Do I need a notary or witness?

Usually not for standard clinic agreements, but certain state-specific matters or third-party requirements may require a notary or witnesses; confirm local rules before execution.

How do I handle HIPAA-covered information?

Include explicit HIPAA authorization language and execute a Business Associate Agreement where necessary; retain records for six years per 45 CFR §164.530(j).

Can the agreement be amended?

Yes. Amendments should be in writing, dated, and signed by all original parties; define notice periods and effective date for amendments in the agreement.

How do I revoke or cancel the agreement?

Follow the termination clause: provide the required written notice, observe any cure periods, and archive the signed termination or revocation with the original record.

What happens if a field is filled incorrectly?

Correct errors promptly with an executed amendment or corrected final document; mismatched names, amounts, or missing signatures can impair enforceability and create compliance exposure.

Electronic Signature
Templates
Legal
Legal Shankle Clinic Agreement

Legal Shankle Clinic Agreement

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

LEGAL SHANKLE CLINIC AGREEMENT

This Legal Shankle Clinic Agreement (the "Agreement") is made and entered into as of by and between (referred to herein as "Clinic"), and (referred to herein as "Client"). The Clinic and the Client are each a "Party" and together the "Parties."

RECITALS

WHEREAS, the Clinic operates a medical-legal clinic that provides evaluations, assessments, and related professional services designed to support legal matters and access to care; and

WHEREAS, the Client seeks to engage the Clinic to provide the services described in this Agreement and the Clinic is willing to perform such services under the terms and conditions set forth herein; and

WHEREAS, the Parties desire to set forth their respective rights and obligations with respect to the performance, payment, confidentiality, and legal responsibilities arising from the provision of clinic services.

NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, the Parties agree as follows:

1. SERVICES

1.1 Scope of Services. The Clinic shall perform the services described in the Service Description field below (the "Services"). The Services shall be performed in a professional manner, consistent with applicable standards of care and professional ethics.

Service Description

2. TERM AND TERMINATION

2.1 Term. The term of this Agreement shall commence on the Effective Date set forth above and shall continue for a period of unless earlier terminated in accordance with this Agreement.

2.2 Termination for Convenience. Either Party may terminate this Agreement for any reason upon providing the other Party with days' prior written notice.

2.3 Termination for Cause. Either Party may terminate this Agreement immediately upon written notice if the other Party materially breaches this Agreement and fails to cure such breach within thirty (30) days following receipt of written notice specifying the breach.

3. FEES AND PAYMENT

3.1 Fees. The Client shall pay the Clinic the fees set forth below for performance of the Services. All fees are exclusive of applicable taxes unless otherwise stated.

Fee Amount Payment Terms

3.2 Invoices. The Clinic shall submit invoices to the Client at the intervals agreed above. Payment shall be made in U.S. dollars to the Clinic's designated address within the period specified in the Payment Terms. Late payments shall incur interest at the rate of 1.5% per month or the maximum rate permitted by law, whichever is less.

4. CONFIDENTIALITY

4.1 Confidential Information. "Confidential Information" means all non-public information disclosed by one Party to the other Party in connection with this Agreement, including clinical records, case notes, assessments, and any protected health information. Confidential Information does not include information that: (a) is or becomes generally available to the public other than as a result of a breach of this Agreement; (b) was lawfully in the receiving Party's possession prior to disclosure; or (c) is developed independently by the receiving Party without use of or reference to the disclosing Party's Confidential Information.

4.2 Obligations. The receiving Party shall: (a) maintain the confidentiality of Confidential Information with at least the same degree of care it uses to protect its own confidential information but not less than reasonable care; (b) limit disclosure to employees, contractors, or agents who have a need to know and who are bound by confidentiality obligations; and (c) not use Confidential Information except as necessary to perform its obligations under this Agreement. The Parties acknowledge that monetary damages may be insufficient to remedy a breach and agree that injunctive relief shall be available in addition to other remedies.

Does the Services involve protected health information? Yes

5. RECORDS, ACCESS, AND AUDIT

5.1 Records. The Clinic shall maintain adequate records of Services provided, invoices, and other documentation necessary to substantiate performance and fees. Such records shall be maintained in accordance with applicable law and professional standards.

5.2 Inspection and Audit. Upon reasonable prior notice, and not more frequently than once per year absent suspected noncompliance, each Party shall permit the other Party or its authorized representative to inspect records reasonably related to the performance of this Agreement during normal business hours.

6. INDEMNIFICATION

6.1 Mutual Indemnification. Each Party (the "Indemnifying Party") shall indemnify, defend, and hold harmless the other Party (the "Indemnified Party"), its officers, directors, employees, and agents from and against any losses, liabilities, damages, costs and expenses (including reasonable attorneys' fees) arising out of or resulting from the Indemnifying Party's negligent acts, willful misconduct, or material breach of this Agreement.

7. INSURANCE

Insurance Requirements

7.1 The Clinic shall maintain, at its expense, professional liability insurance and general liability insurance with limits sufficient to meet the Clinic's obligations under this Agreement. Upon request, the Clinic shall provide certificates of insurance to the Client.

8. LIMITATION OF LIABILITY

8.1 EXCEPT FOR LIABILITY ARISING FROM A PARTY'S GROSS NEGLIGENCE, WILLFUL MISCONDUCT, OR INDEMNIFICATION OBLIGATIONS, IN NO EVENT SHALL EITHER PARTY BE LIABLE TO THE OTHER FOR CONSEQUENTIAL, INCIDENTAL, SPECIAL, PUNITIVE, OR INDIRECT DAMAGES, OR FOR LOST PROFITS, WHETHER IN CONTRACT, TORT, OR OTHERWISE. THE AGGREGATE LIABILITY OF EITHER PARTY FOR ANY CLAIM ARISING OUT OF OR RELATING TO THIS AGREEMENT SHALL NOT EXCEED THE FEES PAID BY THE CLIENT TO THE CLINIC UNDER THIS AGREEMENT DURING THE TWELVE (12) MONTHS PRECEDING THE EVENT GIVING RISE TO THE CLAIM.

9. COMPLIANCE WITH LAW

9.1 Each Party shall comply with all applicable federal, state, and local laws, regulations, and professional standards in the performance of its obligations under this Agreement. Each Party shall obtain and maintain all licenses, permits, and approvals required for its performance hereunder.

10. NOTICES

10.1 All notices required or permitted under this Agreement shall be in writing and shall be deemed delivered when delivered in person, by nationally recognized overnight courier, or three (3) business days after deposit in the U.S. mail, postage prepaid, to the addresses specified below or to such other address as a Party may specify by notice in accordance with this Section.

Clinic Notice Address Client Notice Address

11. AMENDMENTS, WAIVER, AND COUNTERPARTS

11.1 Amendments. This Agreement may be amended only by a written instrument signed by duly authorized representatives of both Parties.

11.2 Waiver. The failure of either Party to enforce any right or remedy under this Agreement shall not constitute a waiver of such right or remedy or of any other right or remedy.

11.3 Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed an original, and all of which taken together shall constitute one and the same instrument. Signatures transmitted by electronic means shall be deemed originals for all purposes.

12. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

12.1 Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the state specified below without regard to its conflict of law rules. State of Governing Law:

12.2 Entire Agreement. This Agreement, together with any exhibits or attachments expressly incorporated herein, constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations, and discussions, whether oral or written.

12.3 Severability. If any provision of this Agreement is held to be invalid, illegal, or unenforceable in any respect, the validity, legality, and enforceability of the remaining provisions shall not in any way be affected or impaired.

MISCELLANEOUS INFORMATION

Billing Contact Name Billing Address Additional Terms or Special Provisions

For Clinic (Shankle Clinic):

Printed Name:

By:

Date:

For Client:

Printed Name:

By:

Date:

What the Legal Shankle Clinic Agreement Is

The Legal Shankle Clinic Agreement is a standardized service contract used by clinics and affiliated legal teams to document the scope of assistance, client responsibilities, fees, and confidentiality protections for legal or administrative clinic services. It sets expectations for intake, representation limits, payment or pro bono terms, and data handling. The agreement is often used where clinical legal services intersect with patient care, and it can be executed electronically under U.S. e-signature law provided the parties demonstrate intent, consent, attribution, and retention.

Why using a clear clinic agreement matters

A written agreement clarifies roles, reduces disputes, documents consent for shared records, and establishes fee and confidentiality terms needed for compliance with healthcare and legal obligations.

Who typically completes the Legal Shankle Clinic Agreement

The agreement is completed by staff who manage intake, clinicians coordinating legal support, and authorized signatories for the clinic or legal provider.

Clinic administrators and intake coordinators who collect client data and set service expectations.
Staff attorneys or supervising lawyers who confirm scope, conflicts, and representation limits.
Clients or patients who provide consent, acknowledge fees, and accept confidentiality terms.

Accurate completion ensures enforceability and a clear record for clinical, legal, and compliance teams.

Primary signers and their roles

Clinic Lead

The authorized clinic administrator or director who signs to bind the clinic. They confirm service scope, fee terms, and any delegation to outside counsel.

Client / Patient

The individual receiving services who signs to show consent to the agreement terms, data sharing, and any limits on representation or billing arrangements.

Essential parts of a professional clinic agreement

A robust Legal Shankle Clinic Agreement organizes responsibilities, scope, fees, records handling, signatures, and dispute resolution so all parties know their rights and obligations.

Parties

Clear identification of each party by full legal name, role (clinic, patient, attorney), and contact information to avoid ambiguity about who is bound by the agreement.

Scope of Services

A precise description of the legal or administrative services provided, any exclusions, and whether representation is limited, consultative, or full representation.

Fees and Consideration

State whether services are free, fee-for-service, or subsidized; list exact amounts, billing intervals, and how refunds or pro bono limits apply.

Confidentiality & HIPAA

Specify permitted disclosures, data handling practices, and any required HIPAA business associate addendum where protected health information is involved.

Signatures and Dates

Include signature blocks for each signer, printed name, title, and date; state whether electronic signatures are accepted and how evidence of consent is retained.

Governing Law & Dispute

Designate the governing state law and a dispute resolution method (mediation/arbitration or court jurisdiction) to reduce future jurisdictional disputes.

Step-by-step: filling the Legal Shankle Clinic Agreement

Complete the form in sequence to reduce errors: identify parties, confirm scope, set fees, obtain authorizations, then sign and retain the record.

01

1. Identify parties: Enter full legal names and addresses for clinic and client.
02

2. Define scope: Write a clear, bounded description of services and exclusions.
03

3. Record fees: Specify amounts, billing rules, and payment methods.
04

4. Authorize and sign: Collect signatures, dates, and any witness or notary details.

Typical digital workflow settings

Configure your online workflow to match signing order, authentication, and retention policies required by the clinic.

Field	Configuration
Signing Order	Clinic then client then supervising attorney
Authentication	Email link or SMS code; stronger KBA if required
Document Retention	Store encrypted copy for the retention period
Notification Settings	Auto-notify each signer at each step

How eSigning and routing typically operate

An online signing workflow sends the document, collects authentication, enforces signing order, captures audit data, and stores the completed record securely.

Upload: Sender uploads the agreement and places fields.
Assign Signers: Add email addresses and set signing order.
Authenticate: Signer verifies identity via chosen method.
Complete & Store: Signed PDF and audit trail saved in repository.

Digital delivery and integration considerations

Confirm platform supports required authentication, storage encryption, and integrations before sending the agreement.

Integrations: Salesforce, NetSuite, Microsoft 365 supported
Formats: PDF, DOCX, and HTML accepted
Access Controls: Role-based permissions available

Ensure the chosen platform supports HIPAA, audit trails, and export of signed records for compliance and internal archives.

Security and compliance essentials for the agreement

Encryption: TLS 1.2/1.3 in transit, AES-256 at rest

Audit Trail: Full timestamp and IP logging

HIPAA BAA: Available where PHI is handled

21 CFR Part 11: Controls for FDA-regulated records

Access Controls: Role-based signer and viewer rights

Data Residency: Configurable per enterprise needs

Common preparation errors to avoid

Using informal names instead of full legal entity names can break enforceability and payment routing.
Leaving ambiguous scope or open-ended service descriptions increases dispute risk over obligations and billing.
Failing to include HIPAA authorization language when PHI is shared can create regulatory exposure under 45 CFR §164.502.
Skipping witness or notary fields where state or third-party requirements exist can invalidate certain rights or recordings.

Consequences of incorrect or incomplete agreements

Unenforceable Terms: Court may refuse enforcement

HIPAA Fines: Civil penalties and corrective action

Breach Liability: Damages for unauthorized disclosures

Tax Penalties: Reporting failures can trigger IRC penalties

Professional Discipline: Ethics issues for attorneys

Contract Disputes: Costly litigation and delay

Key timing and notice periods to include

Define effective dates, response windows, and amendment notice periods to prevent disputes about when obligations begin and end.

Effective Date:

Set as MM/DD/YYYY when obligations start

Signature Date:

Date each signer executes the agreement

Amendment Notice:

Commonly 30 days' written notice required

Response Deadlines:

Specify client deadlines for documents or fees

Record Retention:

State minimum retention periods for audit

Key milestones and processing stages

Track the agreement lifecycle from drafting to archival using named milestones so each team knows its expected action and timing.

01

Drafting Complete

Agreement finalized and ready for review by parties

02

Client Review

Client reviews and requests changes or consents

03

Execution

All parties sign and dates recorded

04

Archival

Store signed record with audit trail and retention metadata

eSignature vendor pricing and capability snapshot

Compare starting prices and key capabilities for common eSignature providers to match compliance and cost needs quickly.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently asked questions and quick answers

Answers to common legal, signing, and retention questions about the Legal Shankle Clinic Agreement.

Need help? Contact support

Is an electronic signature valid?
Yes. Electronic signatures are legally enforceable under the ESIGN Act (15 U.S.C. §7001) and UETA in most states when intent, consent, attribution, and record retention requirements are met.
Do I need a notary or witness?
Usually not for standard clinic agreements, but certain state-specific matters or third-party requirements may require a notary or witnesses; confirm local rules before execution.
How do I handle HIPAA-covered information?
Include explicit HIPAA authorization language and execute a Business Associate Agreement where necessary; retain records for six years per 45 CFR §164.530(j).
Can the agreement be amended?
Yes. Amendments should be in writing, dated, and signed by all original parties; define notice periods and effective date for amendments in the agreement.
How do I revoke or cancel the agreement?
Follow the termination clause: provide the required written notice, observe any cure periods, and archive the signed termination or revocation with the original record.
What happens if a field is filled incorrectly?
Correct errors promptly with an executed amendment or corrected final document; mismatched names, amounts, or missing signatures can impair enforceability and create compliance exposure.

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now