Common Contracts
1 similar Informed Consent Agreement contracts
INFORMED CONSENTInformed Consent Agreement • June 12th, 2018
This Agreement is intended to provide you with important information regarding the practices, policies and procedures of Dagmara Svetcov, LMFT (herein “Therapist”), and to clarify the terms of the professional therapeutic relationship between Therapist and you (herein “Clients”). Please read this Agreement in its entirety carefully. Any questions or concerns regarding the contents of this Agreement should be discussed with Therapist prior to signing it. When you sign this Agreement, it will also represent an agreement between you and Therapist. You may revoke this Agreement in writing at any time. That revocation will be binding on Therapist unless (1) Therapist has taken action in reliance on it, (2) there are obligations imposed on Therapist by your health insurer in order to process or substantiate claims made under your policy, or (3) you have not satisfied any financial obligations you have incurred.
