MELANIE DAVIS, LCSWAgreement for Service / Informed Consent for Minors • July 2nd, 2014
Contract Type FiledJuly 2nd, 2014This Agreement has been created for the purpose of outlining the terms and conditions of services to be provided by Melanie Davis, LCSW for the minor child(ren) (herein “Client”) and is intended to provide [name of parent(s)/legal guardian(s)] (herein “Representative(s)”) with important information regarding the practices, policies and procedures of Melanie Davis, LCSW (herein “Therapist”), and to clarify the terms of the professional therapeutic relationship between Therapist and Client. Any questions or concerns regarding the contents of this Agreement should be discussed with Therapist prior to signing it.