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Payment Forms

This package contains documents relating to fees and payment including:

 

Invoice/Receipt Template
Reduced Fee Agreement
Health Insurance Details Form
Third Party Payment Agreement

£47.00

Payment Forms

Description

Our Therapy Contract contains a comprehensive section detailing fees for appointments and any additional services.

These templates are useful appendices to a therapy contract for special circumstances where you may agree a reduced fee or a third party may be responsible for payment.

Invoice/Receipt Template

This is a template for use as an invoice or receipt with space to input
client details, appointment dates and fees along with payment
instructions.

Reduced Fee Agreement

This document is intended to be supplemental to a Therapy Contract (also known as a contract or Terms & Conditions).

It provides a framework for offering lower fees to clients whom you would like to work with but are unable to pay your full fee. The fee amount, number of sessions and expiry date are stipulated, followed by client and therapist agreement.

Health Insurance Details Form

This template contains space for collecting a client’s name, policy number and pre-authorisation details as well as other pertinent insurance related information. The reason for obtaining agreement is so that you have written permission to provide invoices and receipts detailing dates of appointments and so that you have relevant information for the insurance company to accept correspondence from you.

Third Party Payment Agreement

We recommend that in the case of a third party agreeing to pay for treatment, you obtain your client’s permission to communicate with the third party regarding billing. The third party could be a parent, family member, partner, employer or other benefactor.

This form requests guarantor details in order that you can arrange payment with them directly and an optional template which you can use to notify guarantors of their responsibility.

The reason for obtaining agreement is so that you have written permission to provide invoices and receipts detailing dates of appointments. This is not intended for collecting permission to provide or obtain information other than what is required for billing. If you intend to discuss anything other than billing with the guarantor, we recommend that you obtain a signed Release of Information.

We offer this form separately from the Therapy Agreement (also known as the contract or Term & Conditions) in order that it can be added only when relevant.

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Payment Forms
Payment Forms

£47.00

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