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Common use of Treatment Authorization Clause in Contracts

Treatment Authorization.  I request BHSI to plan and provide treatment to me (or my minor child) with my participation. I understand that I may withdraw this consent and terminate treatment at any time, for any reason.  I understand that the treatment relationship is considered terminated if I have not been seen at BHSI for more than one year.  I agree to have BHSI call, text, or email me to confirm appointments and/or to address billing issues.  I permit XXXX to leave a phone message about my appointment.

Appears in 3 contracts

Samples: Treatment Agreement, Treatment Agreement, Treatment Agreement

Treatment Authorization. I request BHSI to plan and provide treatment to me (or my minor child) with my participation. I understand that I may withdraw this consent and terminate treatment at any time, for any reason. I understand that the treatment relationship is considered terminated if I have not been seen at BHSI for more than one year.  I agree to have BHSI call, text, or email me to confirm appointments and/or to address billing issues.  I permit XXXX to leave a phone message about my appointment.

Appears in 1 contract

Samples: Treatment Agreement