For all associations of independent practitioners
(To be included as part of one's informed consent statement)
As you know, I work with a group of independent mental health professionals, under the
name (Name of Practice). This group is an association of independently practicing
professionals which share certain expenses and administrative functions. While the
members share a name and office space, I want you to know that I am completely
independent in providing you with clinical services and I alone am fully responsible
for those services. My professional records are separately maintained and no member
of the group can have access to them without your specific, written permission.
For Management Services Organization
(To be included on all bills, or other official communications to consumers)
(Name of Group) is a corporation which provides administrative and management services
to mental health professionals. As an independent practitioner, your provider is solely
responsible for all matters concerning your clinical care and all questions about that
care should be addressed to her/him.
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