Financial

Between Sessions offers financial therapy forms that help keep you organized and on track with your practice. Download our counseling forms online and spend more time with your patients and less time managing the financial aspects of your practice. Check out other counseling form options on our website, including intake forms, office management forms, and more.

bullet Fact Sheets
Principles of Ethical Payment & Billing for Therapist — This fact sheet describes general ethical guidelines for billing and payment for therapeutic services. It includes links to the specific guidelines of various professional organizations. PDF

bullet Forms
Superbill — A Superbill is an itemized form used by healthcare providers to reflect rendered services. A Superbill is the main data source for creation of healthcare claim, which is submitted to payers to insurance companies or other payers. (0517)

Telemental Health Session Notes — This form can be used to document Telemental health sessions via phone, video chat, text, or email. It is designed to be used for billing as well as clinical purposes. The form is in MSWord format so you can change it as you see fit to suit your professional needs. Form Type: MSWord (0315)

Receipt For Therapy Sessions — This form can be used to give to a client as a receipt for services. There is one receipt for monthly services and one for individual sessions. This form is intended to be modified by the individual therapist. Form Type: MSWord (0215)

Sliding Scale Fee Agreement — This form can be modified to state a therapist’s sliding scale schedule and to obtain a signed agreement regarding the terms of a reduced fee. Type of Form: MSWord (1114)

Authorization for Recurring Credit Card Charges — This form can serve as a template for therapists or counselors to use in getting permission to charge their clients by credit card for recurring services. (MSWord)

Termination Letter for “No-Shows” — This template can be used for clients who frequently don’t show up without notification. Modify it to suit your own professional needs. (MSWord)

Letter of Termination to Client for Non-Payment — This modifiable form can be used as a template when a client must be terminated for non-payment of agreed upon fees. (MSWord)

Weekly Expense Log — This form can be used for therapists to keep track of their weekly expenses. (MSWord)

Payment Agreement for Past Services — This form can be used to document and have the client acknowledge fees owed for past services. (MSWord)

Financial Policy — This form can is a model for financial policies to be reviewed and accepted by clients. (MSWord)

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