Common Contracts
4 similar Agreement for Service / Informed Consent contracts
Martha Perez-Quintanilla, AMFT Associate Marriage Family Therapist #116547Agreement for Service / Informed Consent • July 22nd, 2024
This Agreement is intended to provide [name of patient] (herein “Patient”) with important information regarding the practices, policies and procedures of Martha Perez-Quintanilla, Associate Marriage Family Therapist (herein “Therapist”), and to clarify the terms of the professional therapeutic relationship between Therapist and Patient. The name of this practice is Campbell Teen & Family Therapy and the individual therapist that operates this practice is Ingrid Higgins, MFT (LMFT #43950). Any questions or concerns regarding the contents of this Agreement should be discussed with Therapist prior to signing it.
Stephanie Chase, LMFTAgreement for Service / Informed Consent • September 17th, 2022
This Agreement is intended to provide [name of patient] (herein “Patient”) with important information regarding the practices, policies and procedures of Stephanie Chase, Marriage Family Therapist (herein “Therapist”), and to clarify the terms of the professional therapeutic relationship between Therapist and Patient. The name of this practice is Campbell Teen & Family Therapy and the individual therapist that operates this practice is Ingrid Higgins, MFT (LMFT #43950). Any questions or concerns regarding the contents of this Agreement should be discussed with Therapist prior to signing it.
Ingrid Higgins, LMFTAgreement for Service / Informed Consent • September 17th, 2022
This Agreement is intended to provide [name of patient] (herein “Patient”) with important information regarding the practices, policies and procedures of Ingrid Higgins, Marriage Family Therapist (herein “Therapist”), and to clarify the terms of the professional therapeutic relationship between Therapist and Patient. The name of this practice is Campbell Teen & Family Therapy and the individual therapist that operates this practice is Ingrid Higgins, MFT (LMFT #43950). Any questions or concerns regarding the contents of this Agreement should be discussed with Therapist prior to signing it.
Mitchell Gale, AMFTAgreement for Service / Informed Consent • April 20th, 2020
This Agreement is intended to provide [name of patient] (herein “Patient”) with important information regarding the practices, policies and procedures of Mitchell Gale, Associate Marriage Family Therapist (herein “Therapist”), and to clarify the terms of the professional therapeutic relationship between Therapist and Patient. The name of this practice is Campbell Teen & Family Therapy and the individual therapist that operates this practice is Ingrid Higgins, MFT (LMFT #43950). Any questions or concerns regarding the contents of this Agreement should be discussed with Therapist prior to signing it.
