How to Establish a Private Practice, Part 4: The Fine Print

As you probably know from your work experience, and coursework on ethical and legal requirements, therapists must provide specific information to potential clients and obtain the client's "informed consent" before initiating treatment. That means that clinicians starting a private practice have to have the necessary documents ready when their first client walks through the door.

What do you need?

1) Statement of Client Rights and Responsibilities

This statement should be available to the client to keep for reference, and you should also keep either a signed version, or an acknowledgment that they have received it.

Rights involve all the legal and ethical rights afforded clients, such as the right to participate in treatment planning, decline specific treatments or interventions, not face discrimination, privacy, confidentiality, and to file a grievance. Responsibilities can include maintaining behavioral control, providing accurate information, respecting the privacy and rights of others, participating in treatment, and/or stating whether or not they are willing to adhere to elements of their treatment plan.

2) Consent for Treatment

Clients demonstrate informed consent by signing this document. Therefore, it must contain several specific elements:

a) An explicit statement that the client consents to receive evaluation and/or treatment from you (or a particular clinician, practice, or agency), understands the potential risks and benefits, and that treatment can be discontinued at any time by either party.

b) A statement of the risks and benefits of therapy

c) Information on the Limits of Confidentiality

d) After-hours or emergency coverage policy

e) Clinician's credentials and contact information

The consent for should be signed and dated by the client, and witnessed by you or another staff person, e.g. if you happen to have a receptionist.

3) Notice of Privacy Practices (or Policies)

This has to be pretty specific to comply with HIPAA guidelines. The American Counseling Association has published guidelines (for the Notice of Privacy Practices, as well as Informed Consent, actually) that clarify what you should say. Feel free to take a look at mine, in the "Introductory Client Packet" on my website. Include signature lines for the client and witness to sign and date that s/he has received a copy of this information.

4) Financial Agreement

Technically part of informed consent, the financial agreement details your fee, whether you will work with the client's insurance company, when payment is due, fees for missed appointments and returned checks, collections, etc. The client, or whoever is financially responsible, should sign it.

5) Additional Authorizations

If you do plan to accept insurance, the client will need to sign something that authorizes you to file claims and receive payment on his/her behalf. If you may be reimbursed by workman's compensation, a similar authorization will need to be signed. Finally, parents/guardians will need to authorize the evaluation and/or treatment of any minor child.

6) Authorization to Release or Request Protected Health Information

Complementing the statement of confidentiality, and privacy policy, you should have a form that follows HIPAA guidelines for clients to sign to authorize you to contact other treatment providers. Many health insurers routinely expect that therapists have contact with clients' Primary Care Physicians, and psychopharmacoloists, if applicable. Get in the habit of asking for these releases up front.

Finally, many clinicians ask clients to fill out a registration or "face sheet" with contact information, insurance information, etc. Questionnaires about presenting problem(s), and/or standardized measures may also be given to clients to complete. This part is up to you, and based on clinical rather than legal/ethical grounds.

Am I forgetting anything? If so, please let me know!