The policies and paperwork your therapy practice uses play an essential role in setting expectations and boundaries with patients, supporting you in the event of legal proceedings, and ensuring you get paid.

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Since laws and regulations vary from one state to another, and no two private practices are exactly alike, it’s impossible to provide one-size-fits all policies and paperwork here. 

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But these guidelines will get you started drafting your own forms or adapting prewritten paperwork to your needs.

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Heads up: If you’d like to get a jump start with a complete package of prewritten paperwork for your therapy practice, check out the Essentials Paperwork Packet from Private Practice Pro. It includes every document listed below.

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Authorization for Release of Information

This form, signed by your client, authorizes you to share information from your sessions with any of the individuals or institutions listed.

It should be signed in the event you need to share clinical information with a third party.

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The Authorization for Release of Information should include:

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• Your client’s name and date of birth
• Your name and credentials
• The list of individuals or institutions you’re being authorized to share information with
• The types of information you’ll share
• How the information may be shared (phone, email, etc.)
• Your client’s signature and the date

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You should also include a section confirming that the client understands the terms under which you’ll share their information, and any potential risks. Write it in the first person from the client’s perspective, ie. “I understand that…”

Client Financial Responsibility form

This form, signed by your client, confirms that they understand how much they are expected to compensate you for therapy services, and the conditions of that compensation.

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This form should be signed before you begin working with a new client.

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The Client Financial Responsibility form should include:

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• The name of the person paying for the services (the client or their guardian)
• The name of the person receiving the services
• When they will pay (immediately after sessions or on a monthly/quarterly schedule)
• The client’s responsibilities, including the responsibility to notify you if the plan to stop paying for services
• Confirmation that the client understands they may be charged extra fees in certain instances (for instance if they cancel their appointment at the last minute or if their payment can’t be processed)
• Confirmation that the client understands services may be canceled if they fail to pay
• The client’s signature and the date

Consent for Telehealth Consultation

This form confirms that your client is willing and ready to go ahead with telehealth sessions. 

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You should have your client sign this form before beginning any telehealth therapy with 

them.

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The Consent for Telehealth Consultation form should include:

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• The client’s name and signature, and the date
• Confirmation that the client understands how to use the telehealth software and that they’re prepared to go ahead with telehealth
• Confirmation that the client understands the various benefits (eg. flexibility) and risks (eg. unauthorized access to data)  involved
• Confirmation that the telehealth sessions may discontinue if either you or the client don’t believe they’re the right method to use
• Confirmation that they’ve had a conversation with you about beginning telehealth therapy

Credit Card Authorization Form

This fairly straightforward form lists your client’s credit card information so you can charge them for sessions. You can keep it securely on file to reference in the future.

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The Credit Card Authorization form should include:

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• All the information you need in order to charge your client’s card
• Confirmation that the client consents to being charges for therapy services
• Your name and credentials, or the name of your business
• Your client’s name
• Your client’s signature and the date

Estimate of Benefits

This form lists the amount a client should expect to pay out of pocket after benefits are applied. It’s an estimate based on information the client’s insurance company gives you. 

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You should provide this form after you’ve checked the client’s insurance information and determined how much expense it will cover.

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The Estimate of Benefits form should include:

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• The client’s name
• Your name and credentials, or your business’s name
• The your practice’s address and contact information
• The client’s contact information
• The amount of the client’s deductible
• The amount of the client’s copay
• How much of the deductible the client has paid to date

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You should also include a section:

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• Defining what a copay is
• Defining what a deductible is
• Explaining to whom the client much pay their copay and deductible, respectively, and when
• Text confirming that the client understands the information you’re providing is only an estimate, and that it may change; their insurance provider has the final say

Good Faith Estimate

This form breaks down how much a client can expect to pay if they work with you. 

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You can provide this automatically or at the patient’s request.

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Make clear in the text of this form that it’s not a contract guaranteeing that you’ll charge a certain amount, or a recommendation of a particular course of treatment. 

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Factors affecting the estimate include:

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• Your hourly fee
• The type of service you’re providing
• If you anticipate a certain number of sessions (eg. in the course of group therapy treatment), how many there will be

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Be sure to note these factors on the form.

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You’ll also need to include:

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• The client’s name and contact information
• Your name or your practice’s name and contact information
• What type of services you’ll be providing
• The hourly fee you charge (or fee for a 50 minute session)
• How long the good faith estimate is valid for (typically 12 months)

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Also include a section with estimates covering particular periods of type. For instance:

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• Estimates of weekly cost of one session per week vs. two sessions per week
• Estimate of the cost of three months’, six months, and twelve months’ worth of sessions at a rate of either one or two per month

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Finally, include information about how the client can pursue a complaint with the US Department of Health and Human services if they believe they’ve been overcharged. (Typically $400+ above the amount listed in the Good Faith Estimate.)

Health Insurance Opt-Out

This form simply confirms that the client has decided to opt out of insurance coverage, and that they understand they’ll be paying you out-of-pocket for therapy services.

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It also confirms that the client will inform you in case they start new insurance coverage or decide to start applying their current insurance benefits.

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On the Health Insurance Opt-Out form, include:

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• The client’s name and date of birth
• The client’s signature
• The date on which the client is opting out
• The client’s current coverage
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Informed Consent for Psychotherapy

This form is extremely important. It establishes that the client understands what undergoing psychotherapy entails, and what kind of risks are present.

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You should have your client sign this form before you begin providing them with any therapy services.

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The Informed Consent for Psychotherapy form should also include:

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• A statement outlining their client held privilege of confidentiality, including its limitation
• Under what circumstances you may share anonymous, non-specific information about your sessions with them and how that information will be shared (eg. when consulting with other professionals)
• Expectations and conduct in the event you happen to meet your client outside of a clinical setting

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You may also include information on your rates, your cancellation policy, and how you may or may not conduct sessions using telehealth software.

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The Informed Consent form can vary considerably from one therapist to the next. You can find numerous examples with this google search.

Intake Questionnaire (Adult)

Your intake questionnaire is meant to provide you with all the information you need to start providing a new client with therapy. 

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You should provide an intake questionnaire after a consultation, before you begin formally working with a client.

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Items on your intake questionnaire for adults should include space for them to provide the following information:

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• Name and date of birth
• Contact information, including specific phone numbers or email addresses for confidential communication
• Sex, sex assigned at birth, gender identity, and sexuality
• Occupation
• Relationship status
• Present partner or spouse
• Past and present marriages
• Children or grandchildren
• Parents and step parents
• Whether their parents were divorced. If so, a few notes about their family structure and how it affected them
• Current medical care provider
• Medical history
• List of current medications
• Prescribing psychiatrist for medications (if any)
• Notes about past experiences undergoing psychotherapy
• Family medical history
• Family history of addiction or mental health issues
• Family history of heritable medical issues
• The presenting problem (the reason they’re seeing you)
• The estimated severity of the presenting problem (mild to severe)
• Current drug and alcohol use
• History of drug and alcohol abuse and treatment 
• Past suicide attempts or psychiatric hospitalizations
• Notes about childhood events or conditions that may impact their presenting problem
• Information on any pending civil or criminal litigation, including divorce
• Online activity, including estimated time spent daily on social media, browsing, gaming, texting, work/school, and other activities
• A checklist for chronic health issues or symptoms
• A checklist for chronic mental health symptoms that have lasted longer than six months, including appetite changes, difficulty concentrating, anxiety, depression, fatigue, self-harm, fear, hopelessness, etc.
• Friendships and important relationships
• Religion, belief, and spiritual practices, and the role they currently play in their life
• Notes on their hopes, fears, and the sources of joy in their life
• Their goals or hoped-for outcome attending therapy sessions

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You may choose to modify this list of questions based on your own specializations, or based on questions that frequently come up in therapy sessions which may not be listed above.

Intake Questionnaire (Parent)

Your intake questionnaire for parents or guardians or teenage clients is meant to provide you with all the information you need to start providing their child or dependent with therapy.

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You should provide an intake questionnaire after a consultation, before you begin formally working with the client. This intake questionnaire is provided in addition to the one you give the client.

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Items on your intake questionnaire for parents should include space for them to provide the following information:

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• Parent’s name
• Teen’s name and date of birth
• Parent’s contact information, including specific phone numbers or email addresses for confidential communication
• Their teen’s current medical care provider, medical history, list of current medications, and prescribing psychiatrist (if any)
• Family medical history
• Family history of addiction or mental health issues
• Family history of heritable medical issues
• Parent’s current occupation, and notes about how they balance work and family
• Teen’s past suicide attempts or psychiatric hospitalizations
• Teen’s presenting problem, including a measure of severity, and how the presenting problem affects the parent
• Elements of teen’s developmental/child history important for you to know as their therapist
• Teen’s drug/alcohol use, to parent’s knowledge
• How they feel about their teen’s drug/alcohol use
• How drugs and alcohol are discussed at home
• Whether their teen is sexually active
• Whether their teen’s sexual activity is of concern to them
• How intimacy and sexuality are discussed at home
• Whether their teen is involved in any pending civil or criminal cases
• Information on their teen’s screen time, including home many hours per day they spend on social media, gaming, texting, browsing, doing schoolwork, or other activities
• Any concerns they have about their teen’s screen time and internet use
• A checklist for chronic health issues or symptoms affecting their teen
• A checklist for their teen’s chronic mental health symptoms that have lasted longer than six months, including appetite changes, difficulty concentrating, anxiety, depression, fatigue, self-harm, fear, hopelessness, etc.
• Where their teen goes to school
• How their teen performs academically and socially
• Their teen’s current living situation, and relevant details about custody and housing
• Information on any other family members that may have attended therapy, and the outcomes
• Information on past attendance at family therapy sessions—if any—and outcomes
• Their goals for their teen’s counseling, as well as what they believe to be their teen’s goals and desired outcomes
• Their teen’s strengths, and how they may be of benefit in therapy
• What they perceive to be their teen’s weaknesses and challenges
• Any additional information they’d like to provide
• A statement on if/when you would ever bring up psychiatric medications with their teen, and space for the parent to provide information on their stance on psychiatric medications

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You may choose to modify this list of questions based on your own specializations, or based on questions that frequently come up in therapy sessions which may not be listed above.

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Intake Questionnaire (Teen)

Your intake questionnaire for teen clients is meant to provide you with all the information you need to start providing them with therapy.

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You should provide an intake questionnaire after a consultation, before you begin formally working with the client. This intake questionnaire is provided in addition to the one you give their parents or guardians.

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Items on your intake questionnaire for teen clients should include space for them to provide the following information:

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• Name and date of birth
• Contact information, including specific phone numbers or email addresses for confidential communication
• Sex, sex assigned at birth, gender identity, and sexuality
• Current medical care provider
• Medical history
• List of current medications
• Prescribing psychiatrist for medications (if any)
• Notes about past experiences undergoing psychotherapy
• Family medical history
• Family history of addiction or mental health issues
• Parents, step-parents, and their relationship with them
• Whether their parents were divorced. If so, a few notes about their family structure and how it affected them
• Siblings and their relationship with them
• Relationship status and info about any current romantic relationships
• Employment (if any)
• Where they attend school and which grade they’re in
• How they’re performing in school, how they feel about their performance
• Current living situation
• Support system (family, friends)
• Information about drug and alcohol use
• Information about any struggles with addiction
• How drugs and alcohol are discussed at home
• Sexual activity
• How sex/intimacy is discussed at home
• Any pending civil or criminal legal proceedings
• An overview of their childhood and how it has affected them
• Online activity, including estimated time spent daily on social media, browsing, gaming, texting, work/school, and other activities
• A checklist for chronic health issues or symptoms
• A checklist for chronic mental health symptoms that have lasted longer than six months, including appetite changes, difficulty concentrating, anxiety, depression, fatigue, self-harm, fear, hopelessness, etc.
• Their presenting problem (why they’re seeing a therapist)
• Friendships and important relationships
• Whether they have ever attempted suicide or been hospitalized for psychiatric reasons
• Whether they struggle with thoughts of suicide or self-harm
• Whether they struggle with thoughts of harming others
• Their favorite thing about themselves
• Extracurricular activity and groups
• Where they feel most peaceful/happy
• Their desired outcomes from therapy
• Any additional info they’d like to provide

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You may choose to modify this list of questions based on your own specializations, or based on questions that frequently come up in therapy sessions which may not be listed above.

Official Practice Policies

This document lays out how you will charge your client, how you will interact outside of the clinical setting, their rights to privacy, and other important concerns for both of you.

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Your Official Practice Policies document is sort of a master document specifying ground rules for your client’s relationship with you.

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It should include:

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• Appointment and cancellation policies, including how much notice you require before a cancellation and how much the client is charged if they fail to give you enough notice
• Payment and billing info, including how much you charge by the hour, when your client is expected to pay, what happens if they don’t pay, and how they’ll be notified if your fees change
• Phone accessibility info, including what number they can reach you at, the hours during which you can receive phone calls, what occasions are acceptable for them reaching you by phone
• A social media and internet policy, typically specifying that you won’t follow or interact with the client on social media
• Electronic communication info, typically specifying that you can’t guarantee absolute privacy in regards to email and other forms of internet messaging
• Clinical notes info, explaining what type of notes you’ll take during therapy, how they’ll be stored, and who will have access to them
• A minors policy, specifying what type of information the patient’s parents are legally entitled to
• A termination policy, laying out how termination will occur if either you or the patient decide to end your relationship, the steps that will be taken, and what type of advance notification each party should expect
• Confidentiality info, explaining how you will protect the client’s information and their client confidentiality privilege 
• When you may be required by law to disclose confidential information to third parties
• When disclosure of their information requires the client’s authorization
• When disclosure of their information does not require the client’s authorization
• The client’s rights in regards to their personal information
• Places for the client’s name, signature, and the date where they can acknowledge they understand and consent to your official practice policies

Statement of Insurance Reimbursement

This form, also called a superbill, is used by the client to claim insurance coverage for therapy services.

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Your Statement of Insurance Reimbursement form should include:

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• Your provider information, including name, business name, contact information, and license numbers
• The client’s name and contact information
• Payment and reimbursement information, including diagnosis codes, amount owing, amount already paid, the place of service, and the date of service
• Authorization for the insurance company to pay benefits to you, the provider, signed and dated by the client
• Authorization for you to release relevant information to the insurance provider, signed and dated by you

Termination Summary Form

You fill out this form and keep it on file after you stop treating a client. 

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Your Termination Summary Form should include:

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• The client’s name
• The date you started treating your client and the date you stopped
• A checklist where you can specify the main reason for termination (eg. treatment completed, client refused to continue, etc.)
• Who decided to terminate treatment (whether you, the client, or both)
• The kinds of services rendered (eg. individual, group, or family therapy)
• A general description of the treatment you provided
• Notes on the client’s progress, including their goals, progress, and outcomes
• Your diagnostic impression of the client at time of termination, including and dangers or concerns with compliance, medication, etc.
• Referrals and reasons for referrals, if any
• Follow-up care
• Any additional comments

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There’s one more document no therapy practice should be without: Our HIPAA compliance checklist.

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This post is to be used for informational purposes only and does not constitute legal, business, or tax advice. Each person should consult their own attorney, business advisor, or tax advisor with respect to matters referenced in this post.

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Bryce Warnes is a West Coast writer specializing in small business finances.

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