Free EHR for therapists: what's really free, and what it costs

The three kinds of free EHR

Kind	How it's paid for	The catch to check
Free plan of a paid EHR	Upgrades to paid plans, and sometimes payment processing	Limits on clients, storage or features that push you to upgrade as you grow
EHR included with a network	A share of your insurance payments, or fees on cash-pay sessions	The EHR works only inside the network, on the network's contracts
Open source	Nobody; you pay for hosting, setup and support yourself	You're responsible for security, backups, updates and the hosting BAA

Free options, from their own pages

This is a list of what each option says it offers for free, read on October 24, 2026, not a ranking. Confirm the details on the live page; free tiers change more often than paid ones.

Option	What's free	Limits stated	Best for
Carepatron Free plan	$0 plan listing unlimited clients, telehealth, a client portal, automated online payments and AI note-taking, per its pricing page	1 GB of storage; group telehealth, unlimited storage and branding are on its paid Plus plan	A small cash-pay caseload that wants video and payments in one place
Practice Better Sprout	A free plan, per its Sprout page	3 clients in total, deactivated clients included; its pricing page aims it at students and recent graduates; Starter is $25 a month billed yearly ($35 monthly) for 10 clients	Students and new graduates with a handful of clients
Headway's EHR	Notes, scheduling and video built into its platform, no subscription, per its post on why its EHR is free	For providers in its network; Headway keeps a portion of session payments and doesn't publish the share	Clinicians who want a network's insurance contracts and billing
Grow Therapy	No cost to join, per its providers page	Independent contractor arrangement; a 5% processing fee on cash-pay sessions, per its cash-pay policy	Clinicians who want a network and guaranteed insurance payouts
OpenEMR	Free, open-source EHR software, from open-emr.org	You host it (or pay a host), secure it, back it up and keep it updated	Practices with technical help on staff; rarely a solo therapist

Networks aren't really "free EHRs"; they're a way of taking insurance that happens to include one. We compare them fairly in Headway, Alma and the alternatives, and our leaving Headway or Alma page has a calculator for what a network's share adds up to.

The non-negotiable: a signed BAA

Under HIPAA, any company that creates, receives, keeps or sends your clients' health information for you is a business associate, and you need a written business associate agreement with it before you use it (45 CFR 164.502(e) and 164.308(b)). Being free doesn't change that. HHS's cloud computing guidance says a cloud service that stores health information is a business associate even if it says it can't read the data.

• Ask before the first client: "Will you sign a BAA on the free plan?" Get it in writing, and keep a copy.
• Open source: the software has no vendor to sign one, but your hosting company does. Your HIPAA checklist still applies: risk analysis, access controls, audit logs, backups.
• Substance use clients: if you're a federally assisted SUD program, 42 CFR Part 2 adds consent and notice rules; our Part 2 guide explains them.

What "free" can cost you

Free covers the subscription. These are the costs that can still show up:

• Payment processing. Card fees apply on free and paid plans alike. A network fee on cash-pay sessions works the same way: at Grow's stated 5%, a $150 cash session costs $7.50, so ten cash sessions a week for 48 weeks is $3,600 a year.
• Insurance claims. Check whether the free plan sends electronic claims and receives ERAs at all, and the price per claim.
• Outgrowing the cap. A 3-client cap that counts deactivated clients is reached sooner than it sounds. Price the plan you'll need in a year, not today.
• Storage. Scanned intake packets, insurance cards and outside records add up. Ask what happens at the cap.
• Moving later. Switching EHRs takes setup time and a new paperwork round for clients. Our switching EHRs guide plans it in about two weeks; choosing well the first time saves that.
• Keeping old records. You must keep records for years after a client's last visit, wherever they live. In Texas the period depends on your license; see how long to keep records in Texas. If a free plan ends, you need an export you can still read.

10 questions to ask any free EHR

1. Will you sign a BAA on the free plan, before I enter any client?
2. How many clients can I have, and do inactive clients count?
3. How much storage, and what happens when I reach it?
4. Can I send insurance claims and receive ERAs, and what does each cost?
5. What does card processing cost, and can I use my own processor?
6. Are reminders, client paperwork, booking and video included, or paid add-ons?
7. Is AI note help included, and is my clients' information used for anything besides my notes?
8. How do I export everything (notes, documents, billing) and in what format? Is there a fee?
9. If you end the free plan, how much notice do I get, and how long can I read my records?
10. What support do free users get?

For the full feature list, use the therapy practice EHR checklist: 60 checks across scheduling, notes, billing, paperwork and data export.

When free is the right answer, and when it isn't

Free is often right if

• You're a student, an associate with a few private clients, or you see three or four clients a week on the side.
• You're cash-pay only and don't need insurance claims.
• You want to take insurance through a network anyway, and its EHR comes with it.

Paying is usually better if

• You bill insurance on your own contracts. Claims checked before they go, ERAs posting payments, eligibility checks and AR aging save more time than a subscription costs.
• You'll grow past a cap within a year. Moving twice costs more than starting on the plan you'll keep.
• You have, or will hire, associates who need supervisor co-signs.

For comparison, here's the paid option we make. Cima EHR's Solo plan is $59 a month for one clinician with unlimited clients, AI note drafting, reminders, a booking page, client paperwork by text, claims checked before they go, superbills, reports and a BAA with every account. Claims are 30¢ each at the clearinghouse's standard rate; a solo clinician sending 80 claims a month pays $99.00. What it doesn't have: built-in video, card processing and live e-prescribing. It's 30 days free, then paid. There's no free plan. See Cima pricing, Cima for therapists, or our honest comparisons with SimplePractice and TherapyNotes. Running a program instead? See the IOP EHR comparison.

Questions

Is there a completely free EHR for therapists?

Yes, with conditions. Carepatron lists a $0 plan with unlimited clients and 1 GB of storage; Practice Better's Sprout plan is free for up to 3 clients; Headway's EHR is free inside its network, which keeps part of each insurance payment; and OpenEMR is free open-source software you host yourself. Check the BAA, caps and fees before you choose.

Is a free EHR HIPAA compliant?

Only if it protects the data properly and signs a business associate agreement with you. HIPAA requires a BAA with any vendor that stores your clients' information, free or not. Ask for it in writing before you enter a client.

Is Headway's EHR free?

Headway says its EHR is free and built into its platform, with no subscription. It's for providers in Headway's network, and Headway earns by keeping a portion of session payments, a share it doesn't publish.

Can I bill insurance with a free EHR?

Sometimes. Network EHRs bill for you under the network's contracts. Free plans of paid EHRs may or may not send claims and ERAs, and may charge per claim. Ask before you rely on it.

What's the cheapest EHR for a solo therapist who bills insurance?

Compare the whole month: subscription, per-claim and ERA fees, add-ons and card processing. Our guide to EHR pricing has published prices side by side and a worksheet. Cima Solo is $59 a month with AI notes included and claims at 30¢.

Sources

1. Carepatron, Pricing & Plans; Managing your subscription. Read October 24, 2026.
2. Practice Better, Sprout; Recent Changes to Practice Better Pricing. Read October 24, 2026.
3. Headway, Why we made our EHR free for therapists; Where Headway's earnings come from. Grow Therapy, Providers; Payment policy for cash-pay appointments. Read October 24, 2026.
4. OpenEMR project site.
5. HHS, Business Associates and Guidance on HIPAA & Cloud Computing; eCFR, 45 CFR 164.502 and 164.308.
6. Cima EHR prices and features: cimaehr.com/pricing and the app (alturaops server/solo).

Vendor names are trademarks of their owners, used only to describe their published plans. Not legal advice. If something here is out of date, tell us.