Forms Included:

• The General Acknowledgement of Forms Form is a first-step given to the client or family member to state that they have read, understood, and agreed to all statements and policies outlined in the forms that you present.
• The Notice of Privacy Practices Form clearly states the responsibilities of the private practice, the uses and disclosures of protected health information, and the patient's rights to privacy. 

• The Acknowledgement of Receiving the HIPAA Form is a form for the client to sign that acknowledges that they have seen the HIPAA notice and understand its contents.

• The Acknowledgement and Assumption of Risk Form can supplement (but does not replace) your professional liability insurance and should be used by clinicians who use equipment that could accidentally cause injury or harm.
  This form is also ideal to add in your own language to cover policies and rules specific to your private practice, as well as state and local laws, regarding COVID-19.

• The Consent for Services Form gives permission to the private practitioner to complete an evaluation and render appropriate therapy services.

Forms Included:

• The Child Intake Form allows you to collect information about the client's developmental, educational, vocational, speech/language, cognition, feeding/swallowing etc. history. (Ideally, this form is sent to the client in advance and have it filled out and returned before their evaluation.)
• The Adult Intake Form allows you to collect information about the client's developmental, educational, vocational, speech/language/cognition/feeding/swallow etc. history.(Ideally, this form is sent to the client in advance and have it filled out and returned before their evaluation.)
• The Session Progress Notes that can be completed after each session with a client which can include your session number, insurance information, NPI / License Number, etc. Having this documentation is critical in the (unlikely but possible!) event of a lawsuit so that you can clearly communicate what happened in your sessions. (Ideally, this form is sent to the client in advance and have it filled out and returned before their evaluation.)
• The Evaluation Report Template that you can modify to meet the exact needs of your practice and use to report your clinical evaluation.
• The Progress Summary Report Template that you can modify to meet the exact needs of your practice and use to report your client progress towards goals over a specified period of time.

Forms Included:

• The Attendance Agreement / Cancellation Policy that clearly outlines the attendance, tardiness, cancellation, bad weather, illness, etc. policies, as well as any fees that the client may be responsible for as a result of a missed session.
• The Credit Card Authorization Form that allows you to bill their credit, debit, or FSA card for services rendered. This includes doing so on card readers, such as Square.
• The Attendance and Record of Payment Form provides a record of all attended sessions (as well as who the payor source for the session was and whether the session was paid or if the payment is pending). Having the client, parent, or responsible party sign and acknowledge that they attended the session encourages payment on the date of service and is useful in the (unlikely but possible!) event of a disputed charge.
• The Payment Policy and Fee Schedule is your place to detail the rates for your services and explain the client's financial responsibility and payment options and terms. Think of this like the legal “menu” of your offerings and the price associated with each service.
• The Superbill Template provides you with a way to collect payments privately and gives your clients and their families an opportunity (although not a promise) to get reimbursed through their insurance in the form of a coded receipt.
• The Health Insurance Verification Form is useful when speaking to your client's health insurance company(ies) to verify their coverage and gather information to help you get paid. 
• The CMS 1500 Form is the standard claim form used by non-institutional providers to bill Medicare for services and/or equipment. It provides information about the client, their corresponding insurance policy, and their diagnosis and treatment.

Forms Included:

• The Communication Preference Form will allow you to collect contact information for your clients, and more importantly, get permission to contact them via various methods (including text message).

• The Record of Client Contact Form can be used to keep track of emails, phone calls, meetings, appointments, and other forms of communication you have with your clients and their family members.

• The Consent for Observation Form is used to get consent FOR THE PRIVATE PRACTITIONER to observe a client in another setting, such as a daycare, school, place of employment, or other environment as needed with space to detail the location.
  
  This form DOES NOT cover the client to be observed at your private practice by a graduate student, intern, or other staff / guests in your private practice.

Forms Included:

• The Screening Permission Forms provide consent from parents for you to conduct a screening with their child (to see if they are within normal limits or should be evaluated further). This is required since they are minors and cannot give consent.

• The Telepractice Consent Form must be filled out by your clients before you begin providing them with telepractice services. General practice forms that are not specific to telepractice will not protect you here!

Forms Included:

• The Consent to Exchange, Obtain and Release Information Form allows you to share and receive information with other professionals for evaluation and treatment planning purposes.
  
  Do not contact or share information with other providers until you have written permission to do so, as this would be a HIPAA violation.

• The Fax Cover Sheet might sound archaic, but faxing is still the gold standard for communicating with physician offices and having the right cover sheet can provide additional protection from inadvertent exposure of your documents. 
• The Physician Referral Form provides an easy way to get referrals from physicians and specialists. It’s a best practice to have these on hand, and depending on the payor source, it may be required. 

Forms Included:

• The Client Testimonial Permission Form will help you gather important “social proof” in the form of testimonials from happy clients and their families to use in powerful marketing tools that will attract new clients. 
  
  Do not contact or share information with other providers until you have written permission to do so, as this would be a HIPAA violation.
• The Fax Cover Sheet might sound archaic, but faxing is still the gold standard for communicating with physician offices and having the right cover sheet can provide additional protection from inadvertent exposure of your documents. 
• The Physician Referral Form provides an easy way to get referrals from physicians and specialists. It’s a best practice to have these on hand, and depending on the payor source, it may be required. 

Forms Included:

• The Independent Contractor Agreement can be used to outline the roles, responsibilities, compensation, and more for your independent contractors.

• The Sample Employee Contract can be used to draft the roles, responsibilities, payment, benefits, and more that you plan to offer.

• The Sample School Contract can be used to provide speech therapy services to local schools through your private practice.

Don't Miss Tax Deductions

When we discuss income goals for private practice owners, it’s important to remember that the numbers discussed are often “pre-tax” income numbers. You are taxed on the profit your business generates. If you have legitimate business expenses, it can lower your tax burden. This list includes some of the most common tax deductions for private practitioners.

The Private Practice Risk Minimizer

Having these Private Practice Clinic Forms is an essential layer of protection that MUST come early when starting your business -- but they aren’t the only form of protection you’ll want to consider. This PDF will break down all of “the legal stuff” into plain English.

The Organized Private Practitioner To-Do Lists

No matter where you’re at in your private practice journey, the best time to get organized is right now! These daily, weekly, and monthly to-do lists were created with the input of multiple SLPS and will help you keep all your ducks in a row as you grow your biz.