Get your Practice Policies and Fees Agreement

This goes at the top of your form. All optional.

Practice or business name

Address

Phone

Contact email

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Untick anything you do not need. You can edit the file afterwards.

Sessions and fees

Appointments and cancellation

Communication

Emergencies

Telehealth (if offered)

Agreement

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These parts depend on your practice and where you work. Write your own wording, or leave a box empty and the form will keep a line for you to fill in later.

Sessions and fees
Prompt: payment due date, accepted payment methods, insurance and receipts.

Appointments and cancellation
Prompt: notice required to cancel, late cancellation fee, missed appointment policy, lateness policy.

Communication
Prompt: how and when clients can contact you, response times, what is and is not appropriate by email or text, social media boundaries.

Emergencies
Prompt: insert crisis resources and your after-hours arrangements.

Telehealth (if offered)
Prompt: platform used, privacy and technology expectations, client location requirements.

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Paper size
US Letter   A4 (UK, Europe)

Files
Fillable PDF   Editable Word file

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