Common Contracts
2 similar Patient Agreement and Authorizations contracts
Patient Agreement and AuthorizationsPatient Agreement and Authorizations • January 10th, 2018
Consent for treatment: I hereby consent to the treatment provided by Robert Jackman, LCPC for Mental Health. I authorize the mental and physical health care services deemed necessary or advisable by my caregiver to address my needs.
Patient Agreement and AuthorizationsPatient Agreement and Authorizations • March 23rd, 2015
Consent for treatment: I hereby consent to the treatment provided by Robert Jackman, LCPC for Mental Health. I authorize the mental and physical health care services deemed necessary or advisable by my caregiver to address my needs.
