Common Contracts
1 similar Consent to Treatment Agreement contracts
Child & Family Psychological ServicesConsent to Treatment Agreement • February 24th, 2022
Consent to Treatment, Privacy Practices, and Payment Policies Agreement Client Name (please print): Date of Birth: Chart #: If not self, state relationship to client: I am voluntarily choosing to enter in to treatment at Child & Family Psychological Services , hereafter referred to as the Organization, and hereby acknowledge that I am over eighteen (18) years of age or am the parent/legal guardian of the child/individual, of sound mind and competent to consent to treatment. Furthermore, I consent to have treatment provided by a contractual psychiatrist, psychologist, social worker, counselor, therapist, or intern in collaboration with the Organization’s Medical Director. I understand that I will be responsible for participating in the development of my own treatment plan.I may terminate, or request a change in, the professional treating me at any time. I understand that it is my right and responsibility to voice any concerns, objections, or doubts I may have regarding the course of tr
