Consent to Treat & Financial Policy — Update / setup form (auth-only) for Health Care / Therapy. Embeddable version — a transparent, chrome-free form that floats over your own website design (pair with the standalone version for a hosted page).

A focused acknowledgment of the core consents and the way billing works for your care — recorded securely on your file before your first visit.

What it collects (by section):

• Consent to treat — Consent to Treat Status [dropdown: Not sent / Sent / Signed / Expired]; HIPAA NPP Acknowledgment [dropdown: Not sent / Acknowledged / Declined]; No-Show/Cancellation Policy Acknowledgment (health) [choice: Yes / No].
• How billing works — Insurance Use Intent [dropdown: Use insurance (in-network) / Out-of-network with superbill / Self-pay / EAP voucher / Sliding scale inquiry]; Payment Method Preference (health) [dropdown: Credit/Debit card / ACH / HSA/FSA card / Cash / Check]; Co-Pay / Co-Insurance Band [dropdown: $0 / $1-$20 / $21-$40 / $41-$70 / $71+]; Sliding Scale Interest [choice: Yes / No / Maybe]. Your intent and method for payment — names and preferences only, never account or card numbers.
• Documents & receipts — Superbill Delivery Preference [dropdown: Client portal / Email / Printed / Not applicable]; Session Summary Delivery Preference (health) [dropdown: None / Brief summary on request / After milestones / Portal access only].

Form type: Update / setup (up), auth-only. Niche: Health Care / Therapy. Deployment: embed.

Best for / surface when: Health Care / Therapy client workflow — consent to treat & financial policy.