Therapist Service Contract

THERAPIST SERVICE CONTRACT

This Therapist Service Contract ("Agreement") is made and entered into as of by and between Therapist Name: , License/Credentials: , Business Address: (hereinafter "Therapist"), and Client Name: , Client Address: , Date of Birth: (hereinafter "Client").

RECITALS

WHEREAS, Therapist is duly licensed to provide professional mental health and therapeutic services in accordance with applicable law and possesses the education, training, and experience necessary to provide the services described herein; and

WHEREAS, Client desires to obtain clinical therapeutic services from Therapist and to engage Therapist on the terms and conditions set forth in this Agreement; and

WHEREAS, the parties intend by this Agreement to set forth their respective rights and obligations with respect to the provision of therapeutic services.

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

1. SERVICES

1.1 Scope. Therapist will provide therapeutic services including assessment, treatment planning, psychotherapy, and related activities as appropriate to Client's clinical needs. The general scope, modality, and goals are described below.

1.2 Location and Format. Services will be provided at Therapist's office and/or at alternate locations and via remote/telehealth means as agreed. Telehealth services will be provided only upon Client's consent and subject to Section 8.

2. TERM AND TERMINATION

2.1 Term. This Agreement commences on the effective date set forth above and continues until terminated by either party in accordance with this Section.

2.2 Termination for Convenience. Either party may terminate this Agreement upon providing at least days' written notice to the other party.

2.3 Termination for Cause. Therapist may immediately suspend or terminate services if Client engages in conduct that endangers Therapist or others, fails to pay fees when due, or materially breaches this Agreement.

3. FEES, BILLING AND PAYMENT

3.1 Fees. Client agrees to pay Therapist the following fee per session: $ . Fees for assessments, reports, and non-session services shall be charged at Therapist's standard rates.

3.2 Billing. Therapist will invoice Client for services rendered. Payment is due within days of invoice. Late payments may be subject to a late fee of % per month or the maximum allowed by law, whichever is less.

3.3 Cancellation and No-Show. If Client cancels less than hours before a scheduled session, Therapist may charge up to the full session fee unless otherwise excused. Client agrees to notify Therapist promptly of inability to attend.

4. CONFIDENTIALITY; LIMITS ON CONFIDENTIALITY

4.1 Confidentiality. Therapist will maintain the confidentiality of Client communications and records in accordance with applicable law. Information disclosed in sessions will not be disclosed to third parties except as provided in this Section or as required by law.

4.2 Exceptions. Confidential information may be disclosed to the extent necessary when: (a) there is a reasonable belief that Client poses imminent risk of harm to self or others; (b) suspected abuse or neglect of a child, elder or dependent adult is required to be reported by law; (c) disclosure is required by court order; or (d) Client provides written authorization to release information.

5. CLIENT RESPONSIBILITIES

Client shall provide complete and accurate information to Therapist, attend scheduled appointments, notify Therapist promptly of cancellations, and comply with treatment plans. Client acknowledges that progress requires active participation and may involve emotional discomfort.

6. RECORDS AND ACCESS

Therapist will retain clinical records in accordance with professional standards and applicable law. Client may request access to records; Therapist may provide copies or summaries and may charge a reasonable fee for copying and reproduction.

7. INFORMED CONSENT; RISKS

Client acknowledges receipt of information regarding the nature of therapy, possible risks and benefits, alternatives, and the voluntary nature of treatment. Client agrees to participate voluntarily and to ask questions regarding any aspect of treatment.

8. TELEHEALTH / REMOTE SERVICES

8.1 Consent. Client consents to receive telehealth services where appropriate. Client understands limitations of remote services, including potential technology failures and limits to confidentiality.

Client consents to telehealth services.

9. LIMITATION OF LIABILITY; INDEMNIFICATION

Client acknowledges that Therapist provides services in a professional capacity but makes no guarantee as to treatment outcomes. To the fullest extent permitted by law, Client releases Therapist from liability for indirect, incidental, special or consequential damages and agrees to indemnify and hold Therapist harmless from claims arising out of Client's breach of this Agreement or Client's negligence.

10. NOTICES

Notices to either party shall be in writing and delivered to the address set forth in the opening paragraph or to an updated address provided in writing. Notice is effective upon personal delivery, three business days after deposit in the U.S. mail, or upon confirmed electronic delivery.

11. AMENDMENTS; WAIVER; COUNTERPARTS

11.1 Amendments. This Agreement may be amended only by a written instrument signed by both parties.

11.2 Waiver. Failure or delay by a party to enforce any provision shall not constitute a waiver of that provision.

11.3 Counterparts and Electronic Signatures. This Agreement may be executed in counterparts, each of which is an original and all of which constitute one instrument. Electronic signatures, including scanned or digital signatures, are acceptable and have the same force and effect as original signatures.

12. GOVERNING LAW; SEVERABILITY; ENTIRE AGREEMENT

12.1 Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to its conflict of laws principles.

12.2 Severability. If any provision of this Agreement is held invalid or unenforceable by a court of competent jurisdiction, the remaining provisions shall continue in full force and effect.

12.3 Entire Agreement. This Agreement contains the entire understanding of the parties regarding the subject matter herein and supersedes all prior and contemporaneous agreements, representations, and understandings, whether oral or written.

13. MISCELLANEOUS

13.1 Relationship of Parties. The parties are independent contractors. Nothing in this Agreement creates an employer-employee relationship, partnership, joint venture, or agency between the parties.

Sign Now