PhoneThis field is for validation purposes and should be left unchanged.Memorandum of Understanding (MOU) Between _______________ and Theragrace Effective Date: _______________ 1. Purpose This Memorandum of Understanding (MOU) establishes the collaborative partnership between [Therapy Practice Name] (“Practice”) and TheraGrace (“Organization”) to increase access to mental health services for individuals experiencing financial hardship due to job loss 2. Scope of Collaboration Theragrace provides financial assistance designed to sustain the client–therapist relationship while operating within the pre-established agreements of the governing practice. Theragrace provides financial support exclusively through 12-session agreements. This financial support does not apply to late cancellations or no-show fees. The Practice will determine the internal distribution of funds to the treating therapist. In accordance with the Theragrace contract, the practice will provide 12 therapy sessions, scheduled weekly or bi-wee*kly.* 3. Roles and Responsibilities Theragrace Responsibilities: Determine client eligibility for financial assistance. Communicate funding approval and session limits to the Practice. Provide payment of $100 per session for each approved client. 4. Confidentiality Both parties will maintain client confidentiality in compliance with all applicable laws, including HIPAA. No client information will be shared without written consent. 5. Payment Terms Payment from Theragrace will be issued according to a mutually agreed-upon invoicing schedule. Each session’s financial support is limited to 12 sessions per client. Late cancellations and no-show fees are excluded from this arrangement. 6. Term and Termination This MOU is effective on the date above and remains in effect for one (1) year unless amended or terminated. Either party may terminate with 30 days’ written notice. Both parties will ensure continuity of care for active clients at the time of termination. If Theragrace elects to terminate its partnership with a Practice, Theragrace agrees to honor all active client agreements in place at the time of termination in order to maintain continuity of care for those clients until the contracted support period has concluded. If the Practice elects to terminate its partnership with Theragrace, Theragrace will cease accepting new client support applications from therapists affiliated with that Practice. However, the Practice may elect to continue honoring existing client agreements until the conclusion of the contracted support period for each active client. Once all active client agreements have been fulfilled, the partnership between Theragrace and the Practice will be considered fully terminated. The decision to continue honoring existing client agreements following termination initiated by the Practice shall remain at the sole discretion of the Practice. 7. Non-Binding Agreement This MOU reflects mutual intentions and is not a legally binding contract. Any binding agreement will be executed separately if required. 8. Amendments Amendments may be made at any time with written consent from both parties. 9. SignaturesPractice Name:Name:Title:SignatureDate MM slash DD slash YYYY TheragraceName:Title:SignatureDate MM slash DD slash YYYY