• AGREEMENT FORM

    Teri's Health Services Suite/Space Rental
  • Format: (000) 000-0000.
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  • Cost Agreement

  • Cost is due the day you use the suite. You will complete the contact form for each day planning to come in and pay the fee by zelle or payment through the payment form. If you zelle you can skip the tax applied to credit card. Each day you will need to pay or week or month depending on your desired use of the suite

    Options: 

    Hourly: $20 

    Daily: $40

    Weekly: $300

    Monthly: $1,000 

    Telehealth Address Suite Practice: $200 per month, due on the 15th of each month. 

     

     

  • If doing telehealth address suite, which address are you putting down for your forms?*
  • Policies & Agreements

    The policy of Psych Suites LLC is for the space to be used in a professional manner at all times. Professionals using the suite are required to be professionals of behavioral health. Psych Suites does not govern your license or ethics but ensures you remain a behavioral health professional in the setting at all times to make the space shared space amongst professional peers. This creates a great community with networking and support. You are required to keep your space you use cleaned and upkept when you leave and to leave all items in the suite when leaving. The library is available for all to use however at no point are you allowed to take the items out of the suite with you. Each item is the property of the suite. You agree to take out your trash, remove any food items you placed in the fridge, and shred any documents you do not need. 

    Scheduling

    Please complete 24 hours prior to the scheduled date you want to reserve. If you are monthly, the cost is due the 27th of the month prior to the start of the month reserving. For example if you want to reserve all of Morch the payment is due April 27. Payment link is on the website to complete. 

     

    Refunds 

    No refunds are provided. 

    Parking

    When using parking, unless otherwise agreed to, you are to park in uncovered parking only.

    Internet/WiFi

    You will need to provide your own internet/Wifi. If you need a mobile hotspot that can be hooked up with Verizon you can purchase one from Teri directly for a one time fee $75. Then you will need to hook up the Wifi hotspot to Verizon. The hotspot will be your property if you purchase from Teri. 

    Key

    You are required to keep the key only on you. You agree you will not make any copies of the key or hand the key out for anyone to use. 

    In the Suite 

    Only you and your client(s) are permitted in the suite unless approved prior to by Teri Hourihan. No children under the age of 16 can be in the suite without supervision. 

    Items used

    Please refrain from using any sprays or scents in the suite that are not first approved by management. Scents can be triggering to people so we want to ensure that at all times we are considering the space that is shared. The office will have peppermint and lavendar incense in incense machines throughout the suite. At no point are you to light candles in the suite or have any type of flamed item. 

    Kitchen Use

    You may use the kitchen at any point while in the suite. Please remove any items you placed in the fridge each time you leave or they will be removed and trashed the same night. Every night the fridge is emptied and cleaned. This is a shared space to take time to refill paper towels when needed by the stock and clean your mess if made. You can help yourself to any bottled water, water in the fountains, or coffee creamer and coffee. 

    Waiting Room

    When your clients come into the waiting children under the age of 16 need to be accompanied by an adult. If a receptionist onsite, you may share your calendar with him/her to greet your clients, take your copayment, and reschedule on your calendar if you choose. 

    Group Room

    You must reserve a group room. Up to 10 people in the room can be in attendance including the leader. Please make sure to only be in the room for your alloted timed and reserved timeframe. 

    Conference Room

    You must reserve a group room. Up to 10 people in the room can be in attendance including the leader. Please make sure to only be in the room for your alloted timed and reserved timeframe. You may use the TV.

     

    Library/Copy/Print Room

    Is available for all to use. Please do not remove items from this room. You may print and use the items. Excessive printing is prohibited. Please be mindful of what you print. 

    HIPAA documents

    Please make sure to shred documents that are PHI. You are responsible to ensure the safety of your charts and client paperwork. 

    Shared Computers 

    You may use the computers in the open space at any time. Please make sure to sign out and turn the computer off. Please check with the front office staff for the password.  

  • Personal Injury Waiver

    This Personal Injury Waiver (the "Waiver") is made by the undersigned for the purpose of utilizing the facilities and premises managed by Psych Suites LLC and Teri's Health Services LLC. (the "Company"), with the location at 14040 N. Cave Creek Rd Suite 104 Phoenix, Az 85022; 7205 S. 51st Ave Suite 204 Laveen, AZ 85339, and in the acknowledgment that in the utilization of the premises and facilities of the Company, occupies risk of personal injury that may arise or happen at any time.

    In consideration of the Company allowing the undersigned to make use of the venue and its facilities and equipment for the relevant purpose by which the Company allows, the undersigned agrees to assume the foreseeable and unforeseeable risk of personal injuries related to the activity, and agrees to release, discharge, and hold harmless the Company, its owner(s) and employees free from any and all liabilities, claims, cause of action, damages, or losses, which may be incurred by the undersigned in using said premises and its equipment and/or facilities, and which may arise from any reason whatsoever, specifically including, but not limited to, any negligence on the part of the owners, its employees, or losses arising from theft or for any other reason whatsoever.

    This Waiver shall be binding upon the parties, their respective heirs, representatives, successors, and assigns.

    In case any part of this Waiver be construed as improper or invalid, such invalidity will affect only that part of this Waiver and the rest shall remain valid and enforceable.

    Any alteration, modification, or amendment to this Waiver shall not be considered as valid unless otherwise written and signed by the undersigned herein.

  • Date*
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    2 digit month, 2 digit day, 4 digit year
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