Get 25+ Forms Now - $300 Off!
Protect Yourself and Your Private Practice
...Using These Digital, Lawyer-Reviewed, Customizable and 
Professional Looking Private Practice Clinic Forms for SLPs and OTs

Private Practice Clinic Forms
Announcing a simplified, streamlined and convenient way to protect yourself and your private practice.

Scroll down to order your forms today!
"I'm thankful for Jena and these forms, so I don't have to spend any extra effort creating my own forms and can focus on more important things like my family and getting this office ready. 

It's peace of mind."

Nicole Edwin, SLP
The Team Behind "Private Practice Clinic Forms"
Created by Jena Castro-Casbon, MS CCC-SLP of The Independent Clinician
Formatted by Publishing Expert, Gordan M.
Reviewed and Approved 
by Samantha V, Esq.
As a private practitioner, it's important to have all of your legal bases covered. Having these forms will help protect yourself in case of a legal situation. 
If You're a Private Practitioner Who Is:
  •   Too overwhelmed to figure out what forms you need
  •   Afraid of making a mistake or overlooking something
  •   Worried about hiring a lawyer due to fear of it costing too much
  •   Putting off starting (or growing) your private practice due to worried   about legalities
  •   Looking for new ideas to make sure your all of your bases are covered
Get These Forms and DON'T Reinvent The Wheel!
There Are Two Sets of Forms to Pick From: 
Choose to Order One or BOTH Sets
The "Essential" Set of Forms
  • General Acknowledgement of Forms
  • HIPAA Notice (aka Notice of Privacy Practices) 
  • Acknowledgement of Receiving HIPAA Privacy Notice 
  • Intake / Case History Form (Pediatric)
  • Intake / Case History Form (Adult)
  • Attendance Agreement / Cancellation Policy
  • Consent For Services Form
  • Attendance and Record of Payment
  • Payment Policy
  • Record of Contacts
  • Payment Policy and Fee Schedule
  • Record of Client Contact
The "Advanced" Set of Forms
  • Evaluation Report
  • Progress Report
  • Progress Note
  • Consent for Exchange, Obtain or Release of Information
  • Health Insurance Verification Form
  • Screening Permission Form
  • Communication Preference Form
  • Consent for Observation
  • Release of Photographs / Videos Form
  • CMS1500 Form (Medicare)
  • Credit Card Authorization Form
  • Acknowledgement and Assumption of Risk
  • How Did You Hear About Us?
  • Client Testimonial Permission Form
  • Physician Referral Form (New!)
  • Fax Cover Sheet (New!)
  • Superbill (New!)
All Forms Are Easily Customizable
in MS Word Format
- Change the wording to apply specifically to your clinic

- Add your logo to the top 

- Save as a PDFs

- Give to clients before their first session
Post Forms on Your Website or Print Paper Copies
There Are Three Sets of Forms to Choose From:
Private Practice Clinic Forms
How the Clinic Forms Work:
1. Save The Forms on Your Computer

2. Modify The Forms to Meet Your Needs

3. Give to Clients

(that's it!)
Private Practice Clinic Forms
Immediate, Unlimited Access 
Purchase today to get instant access to your forms.

1. Register to get a username and password 
2. Log in whenever you want 
You Have a Choice:
Either Hire Your Own Lawyer at $150 - $300/hour to Create All 25+ Forms For You...
...OR Buy These Done For You, Lawyer-Reviewed Forms at an Affordable Price
"Why Did You Buy?"
Real Responses from Beginners:

Real Responses from Established Clinicians:

Here's What More Private Practitioners Are Saying:
"The lawyer who is helping me set up my business was impressed with how well done the forms were. 

I found the forms very easy to edit and they were incredibly time-saving!" 
 Emily Cohen, MA, CCC-SLP
Owner/Speech-Language Pathologist
Austin, TX  |Tandem Speech Therapy
 Ayelet Marinovich
Owner/Speech-Language Pathologist
San Francisco Bay Area, CA  
"YOUR forms saved me time and gave me the confidence that I am not missing anything and have all my ducks in a row. 

Thank you!"

"I periodically update all of my forms and was very pleased to find your very professional-looking forms. Great job."
 Dr. Judith Belk, CCC-SLP, CCC-A
Speech-Language Pathologist and Audiologist
Lake Oswego, OR 
"I am very new to this, so I am extremely grateful that these forms exist as I believe they will help me protect myself and family, as well as maintain a level of professionalism that is a must!"
Jessica Forkins, Speech-Language Pathologist
Beginning Private Practictioner in New Jersey

Don't Reinvent The Wheel: 
I Already Did the Hard Work For You!

Save Time and Money... and Sleep At Night
Knowing That You Have The Necessary Protections

Are these forms better for beginners or established practitioners?
For beginners, having these forms often give peace of mind for those getting started (who don't have the money to hire their own lawyer) 

Established private practitioners can supplement these with forms they already have OR use them to update their current collection. 

**This resource is applicable to ALL LEVELS of private practice** 

How long will I get access to the forms?
Is forever okay?

After payment, you will get immediate access to everything. 

Are the forms be applicable to people outside of the US?
To be honest, I'm not sure.

The Word version is included so that you can modify the forms to fit the individual needs of your private practice / country.

Do they work on PC and Mac?
The forms come Word .doc version. 

Use Microsoft Word to edit the forms (or open in Pages - which may remove some formatting.) 

Is there any branding from The Independent Clinician or Jena on the forms?
NO! The forms are completely unbranded.

Can you add your own logo?
Yes - You can do this easily in MS Word. 

What if I'm not happy with the forms?
If you find that the forms aren't right for you, I stand by my 100% satisfaction guarantee.

FIY: I have sold over 800 copies of these forms and only 1 person has asked for a refund (because they already had too many of the same forms.)

Which professions are these forms best for?
They were created with the needs of speech-language pathologists and occupational therapists in mind.

While the *may work* for physical therapists, social workers, mental health workers, etc. they probably won't meet your needs and you should contact me before purchasing.
Reminder: There Are Three Options to Choose From:
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100% Secure Information
Pick The Forms You Need 
For Your Private Practice
Step #1: Select Which Forms You Need
Step #2: Where Should We Send Access to The Forms?
Step #3: Enter Your Payment Information
Credit Card Number:
CVC Code:
Expiry Month:
Expiry Year:
Dynamically Updated
More Happy Customers
It's Time To Order Your 
Private Practice Clinic Forms
Get Your Lawyer-Reviewed, Customizable, Digital and Professional Looking Clinic Forms for Your Private Practice
Get these forms to make your life easier so that you can make your client's lives easier.
  •  Choose Either Set (or BOTH) According to Your Needs 
  •  All Forms Are Lawye-Reviewed for Wording, Accuracy and Maximum Protection
  •  Forms are Fully Customizable (Add Your Logo, Change the Wording, etc.)
  •  Unlimited Access to Forms in the Member Area
  •  100% Satisfaction Guarantee - No Questions Asked
Even More Happy Customers
Almost Complete...
You're Almost Finished!
Money Back Guarantee
Privacy Guaranteed
100% Secure Information
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