Client Information
Client Name *
Client Name
Main Contact Information
Main Contact Name *
Main Contact Name
Phone *
Phone
HIPPA Acknowledgement *
At So.i.Heard, we keep clinical documentation of each session. We send it to you electronically and keep it safely password protected. We will not share it with others unless we have your express permission, or if it is necessary for legal or safety reasons. Under the Health Insurance Portability and Accountability Act (HIPAA), you have the right to request this information, share it with your other healthcare providers, or have us change information within reason. We are required to notify you immediately if there is any breach in security or problem with the health information we write and keep for you. Please check here to indicate that you understand and agree to this.
Policy Agreement *
I understand that I will be charged for my sessions on the first of every month. I understand that So.i.Heard does not administer refunds. If I plan to withdraw from sessions, I must notify the front desk by the last calendar day of the previous month.