Free Therapist Service Agreement

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Therapist Details

Who is the therapist?
Individual
Corporation-Organization

e.g. Terry Lopez

e.g. Street, City, State ZIP Code






Your Therapist Service Agreement

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THERAPY AGREEMENT

THIS THERAPY AGREEMENT (the "Therapy Agreement") is dated this ________ day of ________________, ________.

Patient

____________________________________________________
(the "Patient")

Therapist

____________________________________________________
(the "Therapist")
  1. BACKGROUND
  2. The Patient is of the opinion that the Therapist has the necessary qualifications, experience and abilities to provide services to the Patient.
  3. The Therapist is agreeable to providing such services to the Patient on the terms and conditions set out in this Therapy Agreement.

IN CONSIDERATION OF the matters described above and of the mutual benefits and obligations set forth in this Therapy Agreement, the receipt and sufficiency of which consideration is hereby acknowledged, the Patient and the Therapist (individually the "Party" and collectively the "Parties" to this Therapy Agreement) agree as follows:

  1. Services Provided
  2. The Patient hereby agrees to engage the Therapist to provide the Patient with the following therapeutic services (the "Services"):
    • _______________________________________________________________
      _______________________________________________________________.

  3. The Therapist will provide the Services on an ongoing, daily, basis, subject to booking and availability.  Unless otherwise agreed between the Parties, the duration of each session will be 30 minutes. The first session is scheduled for ________________ at _____________ and the Parties will confirm the time and date of each successive session at the end of the preceding session.

  4. The Services will also include any other therapeutic tasks which the Parties may agree on. The Therapist hereby agrees to provide such Services to the Patient.
  5. Term of Therapy Agreement
  6. The term of this Therapy Agreement (the "Term") will begin on the date of this Therapy Agreement and will remain in full force and effect indefinitely until terminated by either Party serving notice on the other Party or as otherwise provided in this Therapy Agreement.
  7. In the event that either Party breaches a material provision under this Therapy Agreement, the non-defaulting Party may terminate this Therapy Agreement immediately and require the defaulting Party to indemnify the non-defaulting Party against all reasonable damages.
  8. Except as otherwise provided in this Therapy Agreement, the obligations of the Therapist will end upon the termination of this Therapy Agreement.
  9. Performance
  10. The Parties agree to do everything necessary to ensure that the terms of this Therapy Agreement take effect.
  11. Currency
  12. Except as otherwise provided in this Therapy Agreement, all monetary amounts referred to in this Therapy Agreement are in USD (US Dollars).
  13. Compensation
  14. The Therapist will charge the Patient for the Services at the rate of $_____________ per hour (the "Compensation").
  15. The Therapist will invoice the Patient when the Services are complete.
  16. Invoices submitted by the Therapist to the Patient are due within 30 days of receipt.
  17. In the event that this Therapy Agreement is terminated by the Patient prior to completion of the Services but where the Services have been partially performed, the Therapist will be entitled to pro rata payment of the Compensation to the date of termination provided that there has been no breach of contract on the part of the Therapist.
  18. The Compensation as stated in this Therapy Agreement does not include sales tax, or other applicable duties as may be required by law. Any sales tax and duties required by law will be charged to the Patient in addition to the Compensation.
  19. The Therapist will not be reimbursed for any expenses incurred in connection with providing the additional therapy of this Therapy Agreement.
  20. Insurance
  21. The Patient has the following insurance plan:

    Patient

    Insurance plan

    ______________________

    __________________________________________


  22. Confidentiality
  23. The Patient must only contact the Therapist about confidential matters via telephone.
  24. Confidential information (the "Confidential Information") refers to any data or information relating to the Patient, whether business or personal, which would reasonably be considered to be private or proprietary to the Patient and that is not generally known and where the release of that Confidential Information could reasonably be expected to cause harm to  the Patient.
  25. The Therapist agrees that they will not disclose, divulge, reveal, report or use, for any purpose, any Confidential Information which the Therapist has obtained, except as authorized by the Patient or as required by law.
  26. All written and oral information and material disclosed or provided by the Patient to the Therapist under this Therapy Agreement is Confidential Information regardless of whether it was provided before or after the date of this Therapy Agreement or how it was provided to the Therapist.
  27. Return of Property
  28. Upon the expiration or termination of this Therapy Agreement, the Therapist will return to the Patient any property, documentation, records, or Confidential Information which is the property of the Patient.
  29. Capacity/Independent Contractor
  30. In providing the Services under this Therapy Agreement it is expressly agreed that the Therapist is acting as an independent contractor and not as an employee. The Therapist and the Patient acknowledge that this Therapy Agreement does not create a partnership or joint venture between them, and is exclusively a contract for service. The Patient is not required to pay, or make any contributions to, any social security, local, state or federal tax, unemployment compensation, workers' compensation, insurance premium, profit-sharing, pension or any other employee benefit for the Therapist during the Term. The Therapist is responsible for paying, and complying with reporting requirements for, all local, state and federal taxes related to payments made to the Therapist under this Therapy Agreement.
  31. Right of Substitution
  32. Except as otherwise provided in this Therapy Agreement, the Therapist may, at the Therapist's absolute discretion, engage a third party sub-contractor to perform some or all of the obligations of the Therapist under this Therapy Agreement and the Patient will not hire or engage any third parties to assist with the provision of the Services.
  33. In the event that the Therapist hires a sub-contractor:
    • the Therapist will pay the sub-contractor for its services and the Compensation will remain payable by the Patient to the Therapist.
    • for the purposes of the indemnification clause of this Therapy Agreement, the sub-contractor is an agent of the Therapist.
  34. Autonomy
  35. Except as otherwise provided in this Therapy Agreement, the Therapist will have full control over working time, methods, and decision making in relation to provision of the Services in accordance with the Therapy Agreement. The Therapist will work autonomously and not at the direction of the Patient. However, the Therapist will be responsive to the reasonable needs and concerns of the Patient.
  36. Equipment
  37. Except as otherwise provided in this Therapy Agreement, the Therapist will provide at the Therapist’s own expense, any and all tools, machinery, equipment, raw materials, supplies, workwear and any other items or parts necessary to deliver the Services in accordance with the Agreement.
  38. No Exclusivity
  39. The Parties acknowledge that this Therapy Agreement is non-exclusive and that either Party will be free, during and after the Term, to engage or contract with third parties for the provision of services similar to the Services.
  40. Notice
  41. All notices, requests, demands or other communications required or permitted by the terms of this Therapy Agreement will be given in writing and delivered to the Parties at the following addresses:
    • ______________________
      ______________________________
    • ______________________
      ______________________________

    or to such other address as either Party may from time to time notify the other, and will be deemed to be properly delivered (a) immediately upon being served personally, (b) two days after being deposited with the postal service if served by registered mail, or (c) the following day after being deposited with an overnight courier.

  42. Indemnification
  43. Except to the extent paid in settlement from any applicable insurance policies, and to the extent permitted by applicable law, each Party agrees to indemnify and hold harmless the other Party, and its respective affiliates, officers, agents, employees, and permitted successors and assigns against any and all claims, losses, damages, liabilities, penalties, punitive damages, expenses, reasonable legal fees and costs of any kind or amount whatsoever, which result from or arise out of any act or omission of the indemnifying party, its respective affiliates, officers, agents, employees, and permitted successors and assigns that occurs in connection with this Therapy Agreement. This indemnification will survive the termination of this Therapy Agreement.
  44. Modification of Therapy Agreement
  45. Any amendment or modification of this Therapy Agreement or additional obligation assumed by either Party in connection with this Therapy Agreement will only be binding if evidenced in writing signed by each Party or an authorized representative of each Party.
  46. Time of the Essence
  47. Time is of the essence in this Therapy Agreement. No extension or variation of this Therapy Agreement will operate as a waiver of this provision.
  48. Assignment
  49. The Therapist will not voluntarily, or by operation of law, assign or otherwise transfer its obligations under this Therapy Agreement without the prior written consent of the Patient.
  50. Entire Agreement
  51. It is agreed that there is no representation, warranty, collateral agreement or condition affecting this Therapy Agreement except as expressly provided in this Therapy Agreement.
  52. Enurement
  53. This Therapy Agreement will enure to the benefit of and be binding on the Parties and their respective heirs, executors, administrators and permitted successors and assigns.
  54. Titles/Headings
  55. Headings are inserted for the convenience of the Parties only and are not to be considered when interpreting this Therapy Agreement.
  56. Gender
  57. Words in the singular mean and include the plural and vice versa. Words in the masculine mean and include the feminine and vice versa.
  58. Governing Law
  59. This Therapy Agreement will be governed by and construed in accordance with the laws of the Commonwealth of Virginia.
  60. Severability
  61. In the event that any of the provisions of this Therapy Agreement are held to be invalid or unenforceable in whole or in part, all other provisions will nevertheless continue to be valid and enforceable with the invalid or unenforceable parts severed from the remainder of this Therapy Agreement.
  62. Waiver
  63. The waiver by either Party of a breach, default, delay or omission of any of the provisions of this Therapy Agreement by the other Party will not be construed as a waiver of any subsequent breach of the same or other provisions.

IN WITNESS WHEREOF the Parties have duly affixed their signatures under hand and seal on this ________ day of ________________, ________.

_______________________________
______________________ (Patient)
_______________________________
______________________ (Therapist)
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What is a Therapist Service Agreement?

A Therapist Service Agreement is a contract between a therapist and a client. It details the services the therapist will provide and the compensation they’ll receive in return. The agreement also addresses concerns such as privacy and confidentiality.

Our Therapist Service Agreement is suitable for various types of treatment, including counseling or psychotherapy, physical therapy, occupational therapy, or massage therapy.

A Therapist Service Agreement is also known as:

  • Client-therapist contract
  • Therapy consent form
  • Therapy treatment contract

Who should use a Therapist Service Agreement?

Any form of therapist can benefit from using a Therapist Service Agreement to ensure clear communication with a patient. The document is especially valuable for freelance therapists or small business owners not part of a larger company with pre-existing contracts.

Why do I need a Therapist Service Agreement?

No matter the industry, using Service Agreements is vital when a provider works with a client. Therapy is no exception.

A Therapist Service Agreement sets clear expectations and boundaries with your patient. Putting terms in writing can help you build safe and trusting relationships since the agreement informs your patients of your commitment to confidentiality and privacy.

Having a written agreement can also limit misunderstandings and disagreements regarding things like fees, payment due dates, and late fees.

How do I write a Therapist Service Agreement?

Creating a Therapist Service Agreement is easy and convenient using LawDepot’s template. Collect all the information you need before you start filling out the questionnaire, and remember to double-check the details as you go.

You will need to include the following:

1. Therapy information

Choose the type of therapy you offer and describe the services you’ll be providing your patient. Next, our questionnaire will prompt you to select the state where the therapy will occur. Rules and regulations vary from state to state, and your Therapist Service Agreement will be customized to the jurisdiction you select. 

Include information about the sessions. You can choose to set a start and end date for the treatment, set a specific number of appointments, or offer appointments on an ongoing basis. Also, you can add information about the frequency and duration of the appointments.

2. Party information

Provide your name and address, and do the same for your patient.

If your patient is a minor, you must also include the name and address of their parent or guardian. In this case, the agreement will be between you and the parent or guardian.

3. Financial information

State the amount you will bill your patient per session or per hour. If your patient is paying a deposit before the treatment begins, include the deposit amount.

Decide how long the patient has to pay the invoices and what interest rate you’ll charge for late payments. You should also include details about the patient’s insurance, if applicable.

4. Additional information

Include whether or not you’ll be available to your patient outside of the agreed-upon sessions and if you’ll be charging them for any additional expenses. Add instructions for how your patient can contact you with confidential information.

You can also choose to add additional clauses if there’s other information you need to cover.

What are the confidentiality requirements of a Therapist Services Agreement?

Regarding a Therapist Services Agreement, confidential information refers to any private patient information, whether business or personal, that could cause harm to the patient if shared or released.

By creating and signing a Therapist Services Agreement, you agree that you won’t disclose confidential information unless the patient consents or you are legally required to. Most disclosures of confidential information require consent from the patient.

The Health Insurance Portability and Accountability Act (HIPAA) and state laws ensure patient confidentiality by protecting individually identifiable health information. HIPAA places no restrictions on the use of de-identified health information.

Patients have certain rights under HIPAA, including the rights to:

  • Request access to their own medical information
  • Change any incorrect information
  • Get a list of everyone who has access to their information
  • Request that certain information isn’t shared with others

Are Therapist Service Agreements legally binding?

A Therapist Service Agreement is a legally binding contract. If you and your client have a disagreement, the contract can prove the terms you both agreed to. 

For example, you can use the contract to ground a lawsuit claiming any outstanding or unpaid fees owed by a patient. A patient can also, in some cases, sue a therapist for breach of confidentiality and use the agreement as evidence of the breached obligations.

To change or end a Therapist Service Agreement, use an Amending Agreement or a Termination Agreement.

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Therapist Service Agreement

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