Accessibility

Scroll to Top

Guided Support Request

This field is for validation purposes and should be left unchanged.
What's the state of your practice build, and what would you like the review to focus on?

Report a Bug

This field is for validation purposes and should be left unchanged.
Tell us what you were doing, what you expected to happen, and what happened instead. A sentence or two is plenty.
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY
Include Safety Plan?
Reason for Discharge
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is for validation purposes and should be left unchanged.
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY
Billing Address
Card Type(Required)
MM slash DD slash YYYY

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is for validation purposes and should be left unchanged.
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
License Type
This field is hidden when viewing the form
MM slash DD slash YYYY
988 Suicide and Crisis Lifeline: call or text 988
For immediate danger: call 911 or go to your nearest emergency room
This policy complies with Wisconsin licensing requirements. [OTHER STATES MAY DIFFER]
By signing below, I confirm I have received, read, and understood this after-hours policy.
Client Signature: _____________________________ Date: ____________
Clinician Signature: _____________________________ Date: ____________

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is for validation purposes and should be left unchanged.
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is for validation purposes and should be left unchanged.
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is for validation purposes and should be left unchanged.
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is for validation purposes and should be left unchanged.
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is for validation purposes and should be left unchanged.
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is for validation purposes and should be left unchanged.
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY
Client Address
optional
MM slash DD slash YYYY
Payment Method(Required)
Date superbill is generated
MM slash DD slash YYYY

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
e.g. 90 days / 6 months / annually
Brief financial hardship note
MM slash DD slash YYYY

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is for validation purposes and should be left unchanged.
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is for validation purposes and should be left unchanged.
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is for validation purposes and should be left unchanged.
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY
Session Format(Required)
Leave blank to use practice address.
Leave blank to omit this section from the letter.
e.g. SimplePractice, Doxy.me. Leave blank to omit.
Full URL. Leave blank to omit.
e.g. "Test your link 5 minutes before your session." Leave blank to omit.
Paperwork Delivery Method(Required)
e.g. "Please complete at least 24 hours before your session." Leave blank to omit.
Full URL. Leave blank to omit.
Leave blank to default to clinician name in PDF.
Leave blank to default to practice phone in PDF.
Leave blank to default to practice email in PDF.
Free-form. Leave blank to omit this section from the letter entirely.

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is for validation purposes and should be left unchanged.
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is for validation purposes and should be left unchanged.
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
e.g. 30 days
Refund Method(Required)
e.g. 30 days from date of service
MM slash DD slash YYYY

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is for validation purposes and should be left unchanged.
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Intake Delivery Method(Required)
Consultation Call Offered(Required)
Documents Included in Intake Sequence(Required)
List your documents in the order you send them. One document per line.
Timing: When Documents Are Sent(Required)
Signature/Completion Confirmation Method(Required)
Pre-Session Review Step(Required)

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is for validation purposes and should be left unchanged.
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY
Client Address
MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Telehealth BAA Status
EHR BAA Status
Scheduling BAA Status
Email BAA Status
Payment BAA Status
Phone BAA Status
Client Contact Preference
MM slash DD slash YYYY

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY
Review Cycle(Required)
Primary Device Type(s) Used for Clinical Work(Required)
Devices require password or biometric authentication(Required)
Devices are set to auto-lock after inactivity(Required)
Full-disk encryption is enabled on all clinical devices(Required)
Devices are never left unattended with client records visible(Required)
No unencrypted client records are stored locally on any device(Required)
Password management method(Required)
Multi-factor authentication (MFA) is enabled on EHR login(Required)
MFA is enabled on email used for client communication(Required)
Login credentials are not shared with any other person(Required)
Passwords are changed following any suspected unauthorized access(Required)
Primary ePHI storage method(Required)
No client data is stored in consumer-grade platforms without a BAA(Required)
Examples of consumer-grade platforms that require a BAA before use with client data: standard Google Drive, Dropbox, iCloud, standard Gmail.
Client records are not stored in texts, standard email, or unsecured notes apps(Required)
EHR BAA Status(Required)
Email BAA Status(Required)
Telehealth BAA Status(Required)
Any other platform that stores, transmits, or accesses client info. Enter N/A if none.
Additional Vendor BAA Status
Remote access posture(Required)
VPN use when accessing records off-site(Required)
Client records are never accessed through public Wi-Fi without a VPN(Required)
Breach notification policy is documented(Required)
I know the 60-day breach notification deadline under the HIPAA Breach Notification Rule(Required)
HHS Office for Civil Rights contact information is on file(Required)
MM slash DD slash YYYY
Describe any changes to devices, platforms, or security practices since last review. If first completion, write Initial completion.
Attestation(Required)
Type your full name as your attestation signature.

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Let's Generate Your Document

Fill in your practice details below. Your document will be ready to download immediately after submitting.

This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
MM slash DD slash YYYY

Your document is generated on our secure server and never shared with third parties. Save your PDF to your Practice Document Vault when prompted.

Crisis & Emergency Protocol

This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
Practice Address
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form
This field is hidden when viewing the form

Release of Information

Resources & links

This is your resource panel. When a step requires you to visit a government website, download a template, access a form, or explore a recommended tool or service, you’ll find it here.

On steps where nothing is needed, this panel stays quiet. When it matters, you’ll be directed here from within the step itself, so there’s no need to check it unless you’ve been pointed this way.

Come back here any time you need to revisit a link or re-download something from a completed step.

Close this panel when you’re ready to continue.