Can this agreement be e-signed?

Yes. Under the federal ESIGN Act and state UETA laws, electronic signatures are enforceable when the parties show intent, consent, attribution, and retention. Ensure any consumer-facing disclosure or HIPAA-related consent requirements are followed.

Is a notary or witness required?

Usually no, for ordinary service agreements; however certain states or transaction types may require notarization or witnesses. Confirm state rules where the site is located before final execution.

What about HIPAA and BAAs?

If the agreement involves protected health information, include a signed Business Associate Agreement and document technical, administrative, and physical safeguards to meet HIPAA obligations.

How do I verify signer authority?

Obtain evidence of authority such as a corporate resolution, board minutes, or a title confirmation. For individuals, verify identity and role before accepting a signature.

Can the agreement be amended electronically?

Yes. Create a written amendment, obtain signatures using the same e-signature process, and attach the amendment to the original executed agreement in your records.

What happens if parties disagree post-signature?

Retain all execution metadata, communications, and version history. Use the audit trail and signed copies to resolve disputes; consult counsel for enforcement or breach remedies.

Electronic Signature
Templates
Miscellaneous
Treatment Location Agreement

Treatment Location Agreement

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

Treatment Location Agreement

Parties and Recitals

This Treatment Location Agreement ("Agreement") is made effective as of by and between:

Location Owner: , Address:

Service Provider: , Contact:

WHEREAS, Location Owner owns or controls the premises located at the address above and is willing to make designated space(s) available for the provision of professional treatment services in accordance with the terms set forth herein; and

WHEREAS, Service Provider is duly licensed and qualified to provide the described treatment services and desires to use the Location Owner's premises for the purpose of delivering such services on the terms and conditions set forth in this Agreement; and

NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows.

Scope of Work

Description of Services and Permitted Uses

Service Provider is authorized to use the designated treatment room(s) and common areas only for the purpose described in the Scope of Work and shall not use the premises for any other purpose without the prior written consent of Location Owner. Hours of use: . Days of operation: .

Payment Terms

Location Fee (if applicable) Payment Schedule Late Payment

Any payment not received within days after the due date shall accrue a late fee of per month on the outstanding balance, plus all costs of collection, including reasonable attorneys' fees.

Term and Termination

Term: This Agreement shall commence on Start Date: and continue until End Date: unless earlier terminated in accordance with this Agreement.

Either party may terminate this Agreement without cause upon written notice delivered at least days prior to the intended termination date. Either party may terminate immediately for material breach that remains uncured for days after written notice of such breach.

Insurance and Indemnification

Insurance: Service Provider shall maintain, at its sole expense, professional liability insurance and commercial general liability insurance with limits not less than and shall provide certificates of insurance to Location Owner upon request.

Indemnification: Service Provider shall indemnify, defend and hold harmless Location Owner and its officers, agents and employees from and against any and all claims, liabilities, damages, losses and expenses (including reasonable attorneys' fees) arising out of or in connection with Service Provider's acts, omissions, negligence or willful misconduct in providing services under this Agreement, except to the extent caused by the gross negligence or willful misconduct of Location Owner.

Confidentiality and Records

Each party shall maintain the confidentiality of patient records, business information and other confidential information disclosed by the other party in connection with this Agreement. Service Provider shall be responsible for maintaining all treatment records and protecting patient health information in compliance with applicable privacy and data protection laws. Neither party shall disclose confidential information to any third party except as required by law or with the prior written consent of the disclosing party.

Compliance with Laws and Regulatory Requirements

Service Provider shall at all times comply with all applicable federal, state and local laws, regulations and professional licensing requirements related to the provision of treatment services and shall maintain all required licenses, permits and certifications. Nothing in this Agreement shall be construed to permit the unauthorized practice of medicine or other regulated professions.

Limitation of Liability

Except for liability arising from a party's gross negligence or willful misconduct, in no event shall either party be liable to the other for consequential, incidental, special or punitive damages, whether in contract, tort or otherwise, even if advised of the possibility of such damages.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to conflicts of law principles.

Entire Agreement; Amendments

This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings and negotiations, whether written or oral. Any amendment or modification of this Agreement must be in writing and signed by both parties.

Miscellaneous

Assignment: Neither party may assign its rights or delegate its obligations under this Agreement without the prior written consent of the other party, except that Service Provider may assign to a successor in connection with the sale of substantially all of its business assets.

Notices: All notices required or permitted under this Agreement shall be in writing and delivered to the addresses set forth above or to such other address as a party may designate in writing.

Location Owner

Party Label:

By:

Date:

Service Provider

Party Label:

By:

Date:

What a Treatment Location Agreement is and when it matters

A Treatment Location Agreement is a written contract that defines where specified medical, therapeutic, or clinical services will be provided and the responsibilities of each party related to that location. Typical uses include arrangements between healthcare providers and satellite clinics, temporary treatment sites, mobile health units, or third-party facilities that host services. The agreement clarifies access, equipment, staffing, liability allocation, record custody, data privacy obligations, and any facility-specific requirements that affect patient care or regulatory compliance.

Why a clear Treatment Location Agreement reduces operational and legal risk

A documented agreement prevents misunderstandings about who controls the site, who provides care, and how records and costs are handled, which helps reduce patient-safety gaps, billing disputes, and regulatory exposure.

Typical parties who prepare or sign a Treatment Location Agreement

Confirming the roles and signatures of each party up front reduces delays and supports reimbursement, licensing, and patient-safety requirements.

Healthcare providers and physician groups responsible for delivering care at off-site locations, ensuring clinical oversight and credentialing are documented.
Facility owners or managers who host clinical activities and must confirm site readiness, insurance, and access controls.
Contract administrators, risk managers, or legal counsel responsible for aligning the agreement with licensing, billing, and privacy obligations.

Core components to include in a professional Treatment Location Agreement

A complete agreement identifies the parties, the exact location, permitted services, operational responsibilities, timelines, payment or consideration, and signature blocks with authority statements.

Parties

Full legal names and entity types for each party and the authorized signatory to bind the organization.

Location details

Street address, suite or room identifiers, hours of operation, and any restricted areas or access protocols that affect service delivery.

Scope of services

Specific treatments, procedures, or services allowed at the location plus any staffing, equipment, or credentialing requirements.

Term and renewal

Effective date, expiration or renewal conditions, and termination rights including notice periods and cure opportunities.

Financial terms

Any fees, cost-sharing, billing responsibilities, and how third-party reimbursements are handled.

Data and records

Who controls patient records, HIPAA obligations, access rights, retention responsibilities, and data transfer methods.

Sequential steps to complete and execute the agreement

Complete the form, confirm signatory authority, obtain signatures, and distribute executed copies to stakeholders.

01

Draft: Populate parties, location, services, and dates.
02

Review: Legal, compliance, and risk teams confirm obligations and insurance requirements.
03

Sign: Authorized signers execute with dated signatures or electronic equivalents.
04

Distribute: Provide final executed copies to operations, billing, and record custodians.

Typical online workflow settings for e-execution

Configure the signing workflow so each party receives the correct fields in the right order and with appropriate authentication.

Field	Configuration
Signer order	Sequential or parallel routing to match approval needs
Authentication	Email link with optional SMS or knowledge-based verification
Required fields	Make signatures, dates, and authority fields mandatory
Notifications	Email reminders and final signed copies to all parties

How an e-signed Treatment Location Agreement typically passes between parties

A straightforward e-signature flow reduces friction and creates an auditable record for each step.

Prepare document: Upload template and place signature/date fields.
Add signers: Enter signer emails and set signing order.
Authenticate: Select email, SMS, or stronger verification.
Complete: Executed copies and audit trail distributed automatically.

Common distribution channels and platform integration points

Integrations with CRM, ERP, or cloud storage systems reduce duplicate entry and centralize document management.

Email: Primary delivery method for signing links.
EHR / EMR integrations: Connects executed agreements with patient records.
Document storage: Save executed copies to cloud repositories.

Security and compliance controls to specify in the agreement

Encryption: TLS 1.2/1.3; AES-256 at rest

HIPAA: BAA required for PHI handling

Audit Trail: Detailed timestamp and IP logging

Access Controls: Role-based permissions and MFA

Certifications: SOC 2 Type II; ISO 27001

Retention: Secure storage and tamper-evident archives

Key risks and potential consequences of an incomplete or incorrect agreement

Enforceability risk: Signature or party-name mismatches

HIPAA exposure: Improper PHI handling fines

Operational delay: Unavailable site or credentialing issues

Liability gaps: Unclear indemnity or insurance obligations

Billing denials: Rejected claims from payer disputes

Recordkeeping violations: Failure to meet retention rules

Practical tips to complete the agreement accurately and efficiently

Use these best practices to limit review cycles and align the agreement with compliance, billing, and operational needs.

Standardize a template

Create a single, vetted template with optional exhibits for site-specific items to avoid repetitive redlines and legal fees.

Confirm signer authority

Obtain corporate resolution or evidence of authority for organizational signers to prevent later challenges.

Attach operational exhibits

Include credentialing checklists, equipment inventories, and safety protocols as appendices rather than embedding lengthy lists in the main body.

Use auditable e-signatures

Electronically sign with platforms that record timestamps, IP addresses, and signer authentication to strengthen enforceability.

How to amend or renew a Treatment Location Agreement

Follow a clear amendment workflow to document changes and preserve the original agreement history.

01

Propose change:

Document the amendment language and affected sections.

02

Internal review:

Legal and operations approve the proposed edits.

03

Sign amendment:

Execute with the same authority and signing process as the original.

04

Distribute:

Share executed amendment to all custodians and systems.

05

Recordkeeping:

Attach amendment to original and update retention logs.

06

Renewal trigger:

Note renewal dates in contract management system.

Illustrative use cases for Treatment Location Agreements

Practical examples show how the agreement is applied across settings where services occur off-site or at third-party facilities.

Healthcare clinic

A community clinic hosts a specialist two days per week to expand access

The agreement defines space, staff responsibilities, and record custody
Clear terms enabled credentialing, billing setup with payers, and a HIPAA-compliant data-handling process that reduced administrative delays.

Mobile unit

A health system deploys a mobile screening van to underserved neighborhoods

The document specifies permitted procedures and waste disposal protocols
Having a signed agreement in place allowed rapid deployment while confirming insurance coverage and site access for staff and equipment.

Comparing eSignature vendor basics for executing Treatment Location Agreements

Platform pricing and core features affect cost, compliance, and scale when you execute and store many agreements; signNow is listed first for comparison.

	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, no credit card	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Common questions and practical answers about Treatment Location Agreements

Answers address signature validity, HIPAA concerns, notarization, and amendment procedures commonly encountered during execution.

Need help? Contact support

Can this agreement be e-signed?
Yes. Under the federal ESIGN Act and state UETA laws, electronic signatures are enforceable when the parties show intent, consent, attribution, and retention. Ensure any consumer-facing disclosure or HIPAA-related consent requirements are followed.
Is a notary or witness required?
Usually no, for ordinary service agreements; however certain states or transaction types may require notarization or witnesses. Confirm state rules where the site is located before final execution.
What about HIPAA and BAAs?
If the agreement involves protected health information, include a signed Business Associate Agreement and document technical, administrative, and physical safeguards to meet HIPAA obligations.
How do I verify signer authority?
Obtain evidence of authority such as a corporate resolution, board minutes, or a title confirmation. For individuals, verify identity and role before accepting a signature.
Can the agreement be amended electronically?
Yes. Create a written amendment, obtain signatures using the same e-signature process, and attach the amendment to the original executed agreement in your records.
What happens if parties disagree post-signature?
Retain all execution metadata, communications, and version history. Use the audit trail and signed copies to resolve disputes; consult counsel for enforcement or breach remedies.

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